Whole genome cancer therapy

This Times story describes a cancer therapy made successful by whole genome sequencing of the patient and his cancer cells. Ultimately, RNA sequencing indicated a particular gene (FLT3) might be involved, and luckily for the patient a drug inhibitor was available.

Genotyping was probably not the most expensive part of this treatment. The drug itself costs $300 per day, whereas whole genome sequencing is down to a few thousand dollars for fairly good coverage. The resource that is scarcest is probably the expertise for analyzing the results and planning the treatment.

NYTimes: ... Researchers differ about how soon the method, known as whole genome sequencing, will be generally available and paid for by insurance — estimates range from a few years to a decade or so. But they believe that it has enormous promise, though it has not yet cured anyone. 

With a steep drop in the costs of sequencing and an explosion of research on genes, medical experts expect that genetic analyses of cancers will become routine. Just as pathologists do blood cultures to decide which antibiotics will stop a patient’s bacterial infection, so will genome sequencing determine which drugs might stop a cancer. “Until you know what is driving a patient’s cancer, you really don’t have any chance of getting it right,” Dr. Ley said. “For the past 40 years, we have been sending generals into battle without a map of the battlefield. What we are doing now is building the map.” 

Large drug companies and small biotechs are jumping in, starting to test drugs that attack a gene rather than a tumor type. Leading cancer researchers are starting companies to find genes that might be causing an individual’s cancer to grow, to analyze genetic data and to find and test new drugs directed against these genetic targets. Leading venture capital firms are involved. 

For now, whole genome sequencing is in its infancy and dauntingly complex. The gene sequences are only the start — they come in billions of small pieces, like a huge jigsaw puzzle. The arduous job is to figure out which mutations are important, a task that requires skill, experience and instincts. 

So far, most who have chosen this path are wealthy and well connected. When Steve Jobs had exhausted other options to combat pancreatic cancer, he consulted doctors who coordinated his genetic sequencing and analysis. It cost him $100,000, according to his biographer. The writer Christopher Hitchens went to the head of the National Institutes of Health, Dr. Francis Collins, who advised him on where to get a genetic analysis of his esophageal cancer.