[gdpawel]

Carolyns

Interesting that you point out over 75% of the treatments that have kept you alive over the last 4 years are not approved for breast cancer.

Because tumor response can't be predicted from anatomical location, it was thought that we should start selecting treatments based on what genes and proteins can tell us about how the tumor will respond to a drug. If there is too much reliance on what has clinically been shown to work in some cases for a particular anatomically defined cancer, we may not choose the best therapy for the individual patient.

However, all the mutation or amplification studies can tells us is whether or not the cells are potentially susceptible to this mechanism of attack. They don't tell you if this targeted drug is worse or better than some other targeted drug which may target this particular mechanism of attact.

The cell is a system, an integrated, interacting network of genes, proteins and other cellular constituents that produce functions. You need to analyze the systems’ response to drug treatments, not just one target or pathway (even a few).

Targeted drugs are poorly-predicted by measuring the ostansible target, but can be well-predicted by measuring the effect of the drug on the function of live cells. You still need to measure the net effect of all processes, not just the individual molecular targets.

You can choose to test the biopsied tumor by genetic targets or pathways (does the cell express a particular target that the drug is supposed to be attacking) or by a cell-based assay that profiles the function of cancer cells (is the whole cell being killed regardless of the targeted mechanism/pathway).

Few drugs work the way we think. More emphasis should be put on matching treatment to the patient (personalized medicine), through the use of individualized pre-testing.