No, Your DNA Won't Predict Your Risk for Disease Anytime Soon
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The program is part of an ongoing collaboration between the \u003ca href=\"http://genetics.stanford.edu/\">Stanford Department of Genetics\u003c/a> and \u003ca href=\"http://www.thetech.org/\">The Tech Museum of Innovation\u003c/a>. 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Four groups of scientists couldn’t agree on which differences predicted an increased risk for an irregular heartbeat and which didn’t. And even the differences they compared didn’t turn out to predict much of anything.\u003c/p>\n\u003cp>Until scientists work this out, the dream of truly personalized medicine will remain a distant one.\u003c/p>\n\u003cp>\u003cstrong>Harder Than We Thought\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_97653\" class=\"wp-caption aligncenter\" style=\"max-width: 750px\">\u003cimg class=\"size-full wp-image-97653\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/01/DoctorPatient01142016.jpg\" alt=\"It may be awhile before you are discussing with your doctor what your DNA tells you about your health risks. (NHGRI)\" width=\"750\" height=\"569\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/01/DoctorPatient01142016.jpg 750w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/DoctorPatient01142016-400x303.jpg 400w\" sizes=\"(max-width: 750px) 100vw, 750px\">\u003cfigcaption class=\"wp-caption-text\">It may be awhile before you are discussing with your doctor what your DNA tells you about your health risks. (\u003ca href=\"http://www.genome.gov/dmd/img.cfm?node=Photos/Graphics&id=85342\">NHGRI\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>Listening to the news, you can be forgiven for thinking that sooner rather than later doctors will be able to predict most anything about your health from a look at your DNA.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In fact, right now, they can’t tell you a whole lot.\u003c/p>\n\u003cp>Now this isn’t to say doctors can’t get some very important information from your DNA. There are definitely some differences (or “\u003ca href=\"https://en.wikipedia.org/wiki/Human_genetic_variation\">variants\u003c/a>”) that can be used to help \u003ca href=\"http://ghr.nlm.nih.gov/handbook/genomicresearch/pharmacogenomics\">determine just the right amount of medicine\u003c/a> you should be prescribed. And some real progress is being made in helping to find more targeted \u003ca href=\"http://cancergenome.nih.gov/cancergenomics/whatisgenomics/whatis\">treatments for a patient’s particular cancer\u003c/a>.\u003c/p>\n\u003cp>But the day when you can go to your doctor and she can correctly tell you only from your DNA which ailment you are at a higher risk for is a long way off. This becomes clear in a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2480485\">new study\u003c/a> in the Journal of the American Medical Association (JAMA).\u003c/p>\n\u003cp>In this study researchers couldn’t use DNA to reliably predict who, from a group of 2,202 patients, was at a higher risk for \u003ca href=\"http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300290.pdf\">arrhythmia\u003c/a>, an irregular heartbeat. This is surprising because the two genes they looked at are supposedly \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23788249\">two out there that are better understood\u003c/a>.\u003c/p>\n\u003cp>If we can’t make good predictions on the few genes we understand really well, then odds are we will do even worse with the ones that are still more of a mystery. And these are the genes people will be most interested in, involved in heart disease, type 2 diabetes and so on.\u003c/p>\n\u003cp>This was a small study and it may be that with a larger group of patients, scientists will be able to make better predictions. But regardless it does give us an inkling of what we are up against in the upcoming genomics revolution.\u003c/p>\n\u003cp>It is going to be a hard slog. But in the end, the hope is that it will be worth it because it will make us all healthier.\u003c/p>\n\u003cp>\u003cstrong>The Pitfalls of Personalized Medicine\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_97681\" class=\"wp-caption aligncenter\" style=\"max-width: 750px\">\u003cimg class=\"size-full wp-image-97681\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/01/CrowdDNA.jpg\" alt=\"Figuring out which DNA differences matter is a tricky business. (NHGRI)\" width=\"750\" height=\"664\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/01/CrowdDNA.jpg 750w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/CrowdDNA-400x354.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/CrowdDNA-678x600.jpg 678w\" sizes=\"(max-width: 750px) 100vw, 750px\">\u003cfigcaption class=\"wp-caption-text\">Figuring out which DNA differences matter is a tricky business. (\u003ca href=\"https://www.genome.gov/dmd/img.cfm?node=Photos/Graphics&id=86913\">NHGRI\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>The key to predicting people’s health risks based on their DNA is knowing what to look for. This is even harder to do than you might think because everyone’s genetic make up is so unique.\u003c/p>\n\u003cp>The first step in finding disease-causing DNA differences is to gather up two groups of people and compare their DNA. One group will have the disease and the second, the control group, will not.\u003c/p>\n\u003cp>Any DNA differences more common in the disease group could be implicated in that disease. Lots of follow-up work is done until scientists are left with what they think are the really important variants.\u003c/p>\n\u003cp>Surprisingly, it often isn’t the variants themselves that are important for personalized medicine. Instead, it is the genes they affect that are the real prizes.\u003c/p>\n\u003cp>This is because many of the variants they find in the original study will be rare—not many people will have them. So just looking for them would not be that useful.\u003c/p>\n\u003cp>What they will look for are DNA differences in these genes that no one has seen before. Turns out that there are a lot of these.\u003c/p>\n\u003cp>The final step is to predict which of these other variants will be important for the disease. (These are called “\u003ca href=\"https://www.invitae.com/en/vus-resolution/\">variants of uncertain significance\u003c/a>” or VUS.) This is what this study could not do very well.\u003c/p>\n\u003cp>\u003cstrong>Genes and an Irregular Heartbeat\u003c/strong>\u003c/p>\n\u003cp>A number of previous studies have shown that certain DNA differences in two genes, SCN5A and KCNH2, increase a person’s risk for having an irregular heartbeat. These are the two genes the researchers focused on.\u003c/p>\n\u003cp>Not surprisingly, the researchers didn’t find these DNA variants in any of the 2,202 patients they looked at. Remember these kinds of variants are usually pretty rare.\u003c/p>\n\u003cp>But they did find lots of other differences. They were prepared for this and had lined up four different groups to help them predict which variants might increase a patient’s risk for arrhythmia.\u003c/p>\n\u003cp>They came up with 42 DNA variants in 63 patients that looked like they fit the bill. Unfortunately, none of these DNA differences predicted anything about a patient’s risk for arrhythmia. There was no significant difference in cases of arrhythmia between the group that had these variants and the group that didn’t.\u003c/p>\n\u003cp>In some ways this wasn’t surprising. After all, 63 people is a pretty small group.\u003c/p>\n\u003cp>What is more troubling for personalized medicine is that the four groups making the predictions agreed on very few of the 42 variants. Making accurate predictions is an incredibly important step, and it failed in this study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To get to a future where genetics can help the maximum number of people, we are going to need to be able to use a patient’s DNA to figure out his or her health risks. We’ll get there, but it may take longer than we thought.\u003c/p>\n\n","blocks":[],"excerpt":"A new study shows just how hard it will be to predict people's health risks from their DNA.","status":"publish","parent":0,"modified":1477272177,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":1012},"headData":{"title":"No, Your DNA Won't Predict Your Risk for Disease Anytime Soon | KQED","description":"A new study shows just how hard it will be to predict people's health risks from their DNA.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"No, Your DNA Won't Predict Your Risk for Disease Anytime Soon","datePublished":"2016-01-14T20:20:22.000Z","dateModified":"2016-10-24T01:22:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"97649 http://ww2.kqed.org/futureofyou/?p=97649","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/01/14/predicting-health-risks-from-dna-still-a-way-off/","disqusTitle":"No, Your DNA Won't Predict Your Risk for Disease Anytime Soon","path":"/futureofyou/97649/predicting-health-risks-from-dna-still-a-way-off","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2480485\">new study\u003c/a>, scientists have shown just how hard it will be to one day use your DNA to predict your risk for illnesses.\u003c/p>\n\u003cp>As expected, it wasn’t the reading of the DNA that was the tricky part -- that gets cheaper and easier all the time.\u003c/p>\n\u003cp>Instead, the difficulty was figuring out which DNA differences mattered and which didn’t. Four groups of scientists couldn’t agree on which differences predicted an increased risk for an irregular heartbeat and which didn’t. And even the differences they compared didn’t turn out to predict much of anything.\u003c/p>\n\u003cp>Until scientists work this out, the dream of truly personalized medicine will remain a distant one.\u003c/p>\n\u003cp>\u003cstrong>Harder Than We Thought\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_97653\" class=\"wp-caption aligncenter\" style=\"max-width: 750px\">\u003cimg class=\"size-full wp-image-97653\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/01/DoctorPatient01142016.jpg\" alt=\"It may be awhile before you are discussing with your doctor what your DNA tells you about your health risks. (NHGRI)\" width=\"750\" height=\"569\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/01/DoctorPatient01142016.jpg 750w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/DoctorPatient01142016-400x303.jpg 400w\" sizes=\"(max-width: 750px) 100vw, 750px\">\u003cfigcaption class=\"wp-caption-text\">It may be awhile before you are discussing with your doctor what your DNA tells you about your health risks. (\u003ca href=\"http://www.genome.gov/dmd/img.cfm?node=Photos/Graphics&id=85342\">NHGRI\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>Listening to the news, you can be forgiven for thinking that sooner rather than later doctors will be able to predict most anything about your health from a look at your DNA.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In fact, right now, they can’t tell you a whole lot.\u003c/p>\n\u003cp>Now this isn’t to say doctors can’t get some very important information from your DNA. There are definitely some differences (or “\u003ca href=\"https://en.wikipedia.org/wiki/Human_genetic_variation\">variants\u003c/a>”) that can be used to help \u003ca href=\"http://ghr.nlm.nih.gov/handbook/genomicresearch/pharmacogenomics\">determine just the right amount of medicine\u003c/a> you should be prescribed. And some real progress is being made in helping to find more targeted \u003ca href=\"http://cancergenome.nih.gov/cancergenomics/whatisgenomics/whatis\">treatments for a patient’s particular cancer\u003c/a>.\u003c/p>\n\u003cp>But the day when you can go to your doctor and she can correctly tell you only from your DNA which ailment you are at a higher risk for is a long way off. This becomes clear in a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2480485\">new study\u003c/a> in the Journal of the American Medical Association (JAMA).\u003c/p>\n\u003cp>In this study researchers couldn’t use DNA to reliably predict who, from a group of 2,202 patients, was at a higher risk for \u003ca href=\"http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300290.pdf\">arrhythmia\u003c/a>, an irregular heartbeat. This is surprising because the two genes they looked at are supposedly \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23788249\">two out there that are better understood\u003c/a>.\u003c/p>\n\u003cp>If we can’t make good predictions on the few genes we understand really well, then odds are we will do even worse with the ones that are still more of a mystery. And these are the genes people will be most interested in, involved in heart disease, type 2 diabetes and so on.\u003c/p>\n\u003cp>This was a small study and it may be that with a larger group of patients, scientists will be able to make better predictions. But regardless it does give us an inkling of what we are up against in the upcoming genomics revolution.\u003c/p>\n\u003cp>It is going to be a hard slog. But in the end, the hope is that it will be worth it because it will make us all healthier.\u003c/p>\n\u003cp>\u003cstrong>The Pitfalls of Personalized Medicine\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_97681\" class=\"wp-caption aligncenter\" style=\"max-width: 750px\">\u003cimg class=\"size-full wp-image-97681\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/01/CrowdDNA.jpg\" alt=\"Figuring out which DNA differences matter is a tricky business. (NHGRI)\" width=\"750\" height=\"664\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/01/CrowdDNA.jpg 750w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/CrowdDNA-400x354.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/CrowdDNA-678x600.jpg 678w\" sizes=\"(max-width: 750px) 100vw, 750px\">\u003cfigcaption class=\"wp-caption-text\">Figuring out which DNA differences matter is a tricky business. (\u003ca href=\"https://www.genome.gov/dmd/img.cfm?node=Photos/Graphics&id=86913\">NHGRI\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>The key to predicting people’s health risks based on their DNA is knowing what to look for. This is even harder to do than you might think because everyone’s genetic make up is so unique.\u003c/p>\n\u003cp>The first step in finding disease-causing DNA differences is to gather up two groups of people and compare their DNA. One group will have the disease and the second, the control group, will not.\u003c/p>\n\u003cp>Any DNA differences more common in the disease group could be implicated in that disease. Lots of follow-up work is done until scientists are left with what they think are the really important variants.\u003c/p>\n\u003cp>Surprisingly, it often isn’t the variants themselves that are important for personalized medicine. Instead, it is the genes they affect that are the real prizes.\u003c/p>\n\u003cp>This is because many of the variants they find in the original study will be rare—not many people will have them. So just looking for them would not be that useful.\u003c/p>\n\u003cp>What they will look for are DNA differences in these genes that no one has seen before. Turns out that there are a lot of these.\u003c/p>\n\u003cp>The final step is to predict which of these other variants will be important for the disease. (These are called “\u003ca href=\"https://www.invitae.com/en/vus-resolution/\">variants of uncertain significance\u003c/a>” or VUS.) This is what this study could not do very well.\u003c/p>\n\u003cp>\u003cstrong>Genes and an Irregular Heartbeat\u003c/strong>\u003c/p>\n\u003cp>A number of previous studies have shown that certain DNA differences in two genes, SCN5A and KCNH2, increase a person’s risk for having an irregular heartbeat. These are the two genes the researchers focused on.\u003c/p>\n\u003cp>Not surprisingly, the researchers didn’t find these DNA variants in any of the 2,202 patients they looked at. Remember these kinds of variants are usually pretty rare.\u003c/p>\n\u003cp>But they did find lots of other differences. They were prepared for this and had lined up four different groups to help them predict which variants might increase a patient’s risk for arrhythmia.\u003c/p>\n\u003cp>They came up with 42 DNA variants in 63 patients that looked like they fit the bill. Unfortunately, none of these DNA differences predicted anything about a patient’s risk for arrhythmia. There was no significant difference in cases of arrhythmia between the group that had these variants and the group that didn’t.\u003c/p>\n\u003cp>In some ways this wasn’t surprising. After all, 63 people is a pretty small group.\u003c/p>\n\u003cp>What is more troubling for personalized medicine is that the four groups making the predictions agreed on very few of the 42 variants. Making accurate predictions is an incredibly important step, and it failed in this study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To get to a future where genetics can help the maximum number of people, we are going to need to be able to use a patient’s DNA to figure out his or her health risks. We’ll get there, but it may take longer than we thought.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/97649/predicting-health-risks-from-dna-still-a-way-off","authors":["6177"],"programs":["futureofyou_54"],"categories":["futureofyou_1062","futureofyou_1064"],"tags":["futureofyou_704","futureofyou_705","futureofyou_80","futureofyou_209","futureofyou_706"],"featImg":"futureofyou_97651","label":"futureofyou_54"},"futureofyou_34452":{"type":"posts","id":"futureofyou_34452","meta":{"index":"posts_1591205157","site":"futureofyou","id":"34452","score":null,"sort":[1441299072000]},"guestAuthors":[],"slug":"are-statins-bad-for-me-personalized-medicine-cant-yet-say","title":"Are Statins Bad for Me? Personalized Medicine Can't Yet Say","publishDate":1441299072,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>About 25 to 30 percent of people prescribed statins dump them within a year. I flunked Lipitor after a few wretched months.\u003c/p>\n\u003cp>Statins are prescribed to lower cholesterol in people who show risk factors for cardiovascular disease or diabetes, or who already have them. Side effects can include muscle weakness, diabetes onset and, rarely, permanent muscle damage. These risks are higher in women, with age, and with certain heart and blood pressure drugs.\u003c/p>\n\u003cp>Frustrated with trial and error, I was ready to swap some DNA for some personalized insight. I sent a vial of spit to \u003ca href=\"http://www.bostonheartdiagnostics.com/\">Boston Heart Diagnostics\u003c/a>, a Framingham, Mass., company that tests for statin tolerance using SLCO1B1, a gene that was associated with statin myopathy in studies at Oxford and Duke universities. The company currently only offers this test as a blood test through health care providers but, because I'm a science writer, offered to guide me directly through the process.\u003c/p>\n\u003cp>Genetic tests are conducted using DNA fragments extracted from blood, cells or saliva, which are then copied and amplified to get enough material to test for the precise variant of interest. Then the results are analyzed and shared with the patient. Dr. Ernst Schaefer, the company's chief medical officer, would act as my health care provider to interpret the results.\u003c/p>\n\u003cp>The Boston Heart Diagnostics test identifies three genetic variants, called single nucleotide polymorphisms ,or SNPs, on the SLCO1B1 gene that are associated with how well one metabolizes statins.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>According to the report I received the following week, I was among the 25 percent of people with one copy of the SLCO1B1 variant who metabolize statins like Lipitor or Zocor poorly. Meaning I am 4.5 times more likely to develop muscle myopathy than people without the gene. At least I wasn't among the 2 percent of the population who have both SLCO1B1 gene variants. Then I would be 17 times more likely to develop muscle weakness than the people without the gene.\u003c/p>\n\u003cp>I called Schaefer for more detail. \"The variant is in the transporter that takes up statin in the liver, so people that have the variant have higher blood levels and the statin is more likely to go into muscle,\" he explained. \"Our test is not diagnostic, not confirmatory, just indicates a higher risk of getting a problem on a statin. What is diagnostic is how the patient feels.\"\u003c/p>\n\u003cp>Schaefer recommended that instead of the high dose of Lipitor my doctor had prescribed, I consider a low dose of a different type of statin.\u003c/p>\n\u003cp>Boston Heart is initially targeting its test for people with genetic high cholesterol who are prescribed a PCSK9 inhibitor, a drug newly approved by the Food and Drug Administration. Injected monthly, PCSK9 inhibitors have fewer side effects than statins, but the first drug to hit the market costs over $14,000 a year, compared with $600 for a year's supply of atorvastatin, the generic name for Lipitor.\u003c/p>\n\u003cp>Boston Heart has so far tested over 250,000 patients for statin intolerance but can't yet comment on its prevalence in specific ethnic groups. While this test is not approved by the Food and Drug Administration, it is reimbursed by some insurance.\u003c/p>\n\u003cp>The test costs $100. My health plan still considers prescribing generic drugs for low-risk patients like me on a trial-and-error basis to be cheaper.\u003c/p>\n\u003cp>Insurers will start paying when genetic testing becomes the standard of care agreed upon by physician committees, said Dr. Julie Neidich, a geneticist and laboratory medical director at \u003ca href=\"https://www.pathway.com/\">Pathway Genomics\u003c/a> of San Diego, which also makes a genetic test panel that includes statin intolerance.\u003c/p>\n\u003cp>Could DNA tests like this be the vanguard of personalized medicine? A few months ago, President Obama announced a $215 million \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/30/382659919/obama-wants-funding-for-research-on-more-precise-health-care\">precision medicine initiative\u003c/a> to collect DNA records from 1 million volunteers to develop medical treatments tailored to individual genetic makeup.\u003c/p>\n\u003cp>\"I think we aren't there yet,\" said Neidich. \"While humans have about 20,000 genes, only about 5,000 genes have been reported in the scientific literature to be associated with a disorder found in humans. We have no clue what the other ones do.\"\u003c/p>\n\u003cp>Four DNA-based drugs were just \u003ca href=\"https://personalizedmedicinecoalition.wordpress.com/2015/07/30/turning-a-corner-how-this-months-decisions-at-fda-inform-the-debate-on-drug-costs/\">approved\u003c/a> by the FDA, and in 2014, nine of the 41 FDA-approved medicines were \u003ca href=\"http://www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/2014-fda-approvals-personalized-medicine2.pdf\">personalized treatments\u003c/a>.\u003c/p>\n\u003cp>With the exception of new genetically targeted drugs for chronic hepatitis C, where patients' response depends on the genotype of their infection, all these personalized drugs treat rare diseases and unusual forms of cancer, where disease is caused by one gene or a handful of genes.\u003c/p>\n\u003cp>Health insurance companies are watching these developments like hawks. Indeed, the research arm of Kaiser Permanente, my health care plan, has been accumulating a genetic data bank to study complex conditions like heart disease and diabetes.\u003c/p>\n\u003cp>So far over 200,000 Kaiser Permanente members have contributed DNA samples to be analyzed along with their health records. This matters, because small effects are easier to detect over a large population, particularly in ethnic groups not well-represented in prior clinical trials.\u003c/p>\n\u003cp>So what can cardiac researchers conclude so far from these genetic data? \u003ca href=\"http://www.chori.org/Principal_Investigators/Krauss_Ronald/krauss_overview.html\">Dr. Ronald Krauss\u003c/a>, a lipid specialist at Children's Hospital Oakland Research Institute and the University of California, San Francisco, has been studying cholesterol metabolism for over 40 years and has been collaborating with the Kaiser study.\u003c/p>\n\u003cp>Krauss is concerned about the unseen effects of statin use over time. \"The focus on cholesterol and on relatively uncommon adverse effects of statins such as muscle damage and onset of diabetes could be the tip of the iceberg in terms of biological effects with clinical consequences for some individuals,\" Krauss said. \"These could be either negative or positive. In the lab, we see widespread effects of statins at the cellular and molecular level. Are subtle things happening that affect health over the long term?\"\u003c/p>\n\u003cp>But unlike my single gene test for muscle weakness, predicting a risk or treatment response for complex conditions like heart disease involves sifting through a dog's breakfast of genetic variants of varying impact.\u003c/p>\n\u003cp>\"It is not like \u003ca href=\"http://ghr.nlm.nih.gov/condition/huntington-disease\">Huntington's disease\u003c/a>, where a single identifiable genetic variant can give you the disease,\" said Krauss. \"In complex conditions like heart disease, there are multiple genetic effects, but for the most part, each individual genetic trait has a modest effect.\"\u003c/p>\n\u003cp>But the complications don't stop there. Other factors that can affect a person's disease risk and response to treatment include gut bacteria, RNA, acquired DNA changes, lifestyle and environment. Parsing out the impacts of these variables will require massive computing power and gargantuan data storage capacity to deal with the flood of genetic information to be sequenced and interpreted.\u003c/p>\n\u003cp>\"As we have learned more about the biology of statin response, it is clear that this involves major regulatory networks, and this is big stuff,\" said Krauss.\u003c/p>\n\u003cp>So, time for another cholesterol test. Apparently I'm prone to high cholesterol, no matter how many vegetables I ingest. At least I can experiment with Schaefer's statin recommendations until the bioinformaticians surfing the precision medicine data deluge figure out the big stuff.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://wendywolfson.wordpress.com/\">Wendy Wolfson\u003c/a>\u003cem> is a science writer in Orange County, Calif.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Are+Statins+Bad+For+Me%3F+Personalized+Medicine+Can%27t+Yet+Say&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"Statins made her feel wretched, so she took a DNA test to find out why. But even the doctor with the genetic testing company admits that the test doesn't tell you much more than you already know.","status":"publish","parent":0,"modified":1477274382,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1209},"headData":{"title":"Are Statins Bad for Me? Personalized Medicine Can't Yet Say | KQED","description":"Statins made her feel wretched, so she took a DNA test to find out why. But even the doctor with the genetic testing company admits that the test doesn't tell you much more than you already know.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Are Statins Bad for Me? Personalized Medicine Can't Yet Say","datePublished":"2015-09-03T16:51:12.000Z","dateModified":"2016-10-24T01:59:42.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"34452 http://ww2.kqed.org/futureofyou/?p=34452","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/09/03/are-statins-bad-for-me-personalized-medicine-cant-yet-say/","disqusTitle":"Are Statins Bad for Me? Personalized Medicine Can't Yet Say","nprByline":"Wendy Wolfson","nprStoryId":"436584534","nprApiLink":"http://api.npr.org/query?id=436584534&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say?ft=nprml&f=436584534","nprRetrievedStory":"1","nprPubDate":"Wed, 02 Sep 2015 16:39:00 -0400","nprStoryDate":"Tue, 01 Sep 2015 12:22:00 -0400","nprLastModifiedDate":"Wed, 02 Sep 2015 16:39:15 -0400","path":"/futureofyou/34452/are-statins-bad-for-me-personalized-medicine-cant-yet-say","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>About 25 to 30 percent of people prescribed statins dump them within a year. I flunked Lipitor after a few wretched months.\u003c/p>\n\u003cp>Statins are prescribed to lower cholesterol in people who show risk factors for cardiovascular disease or diabetes, or who already have them. Side effects can include muscle weakness, diabetes onset and, rarely, permanent muscle damage. These risks are higher in women, with age, and with certain heart and blood pressure drugs.\u003c/p>\n\u003cp>Frustrated with trial and error, I was ready to swap some DNA for some personalized insight. I sent a vial of spit to \u003ca href=\"http://www.bostonheartdiagnostics.com/\">Boston Heart Diagnostics\u003c/a>, a Framingham, Mass., company that tests for statin tolerance using SLCO1B1, a gene that was associated with statin myopathy in studies at Oxford and Duke universities. The company currently only offers this test as a blood test through health care providers but, because I'm a science writer, offered to guide me directly through the process.\u003c/p>\n\u003cp>Genetic tests are conducted using DNA fragments extracted from blood, cells or saliva, which are then copied and amplified to get enough material to test for the precise variant of interest. Then the results are analyzed and shared with the patient. Dr. Ernst Schaefer, the company's chief medical officer, would act as my health care provider to interpret the results.\u003c/p>\n\u003cp>The Boston Heart Diagnostics test identifies three genetic variants, called single nucleotide polymorphisms ,or SNPs, on the SLCO1B1 gene that are associated with how well one metabolizes statins.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to the report I received the following week, I was among the 25 percent of people with one copy of the SLCO1B1 variant who metabolize statins like Lipitor or Zocor poorly. Meaning I am 4.5 times more likely to develop muscle myopathy than people without the gene. At least I wasn't among the 2 percent of the population who have both SLCO1B1 gene variants. Then I would be 17 times more likely to develop muscle weakness than the people without the gene.\u003c/p>\n\u003cp>I called Schaefer for more detail. \"The variant is in the transporter that takes up statin in the liver, so people that have the variant have higher blood levels and the statin is more likely to go into muscle,\" he explained. \"Our test is not diagnostic, not confirmatory, just indicates a higher risk of getting a problem on a statin. What is diagnostic is how the patient feels.\"\u003c/p>\n\u003cp>Schaefer recommended that instead of the high dose of Lipitor my doctor had prescribed, I consider a low dose of a different type of statin.\u003c/p>\n\u003cp>Boston Heart is initially targeting its test for people with genetic high cholesterol who are prescribed a PCSK9 inhibitor, a drug newly approved by the Food and Drug Administration. Injected monthly, PCSK9 inhibitors have fewer side effects than statins, but the first drug to hit the market costs over $14,000 a year, compared with $600 for a year's supply of atorvastatin, the generic name for Lipitor.\u003c/p>\n\u003cp>Boston Heart has so far tested over 250,000 patients for statin intolerance but can't yet comment on its prevalence in specific ethnic groups. While this test is not approved by the Food and Drug Administration, it is reimbursed by some insurance.\u003c/p>\n\u003cp>The test costs $100. My health plan still considers prescribing generic drugs for low-risk patients like me on a trial-and-error basis to be cheaper.\u003c/p>\n\u003cp>Insurers will start paying when genetic testing becomes the standard of care agreed upon by physician committees, said Dr. Julie Neidich, a geneticist and laboratory medical director at \u003ca href=\"https://www.pathway.com/\">Pathway Genomics\u003c/a> of San Diego, which also makes a genetic test panel that includes statin intolerance.\u003c/p>\n\u003cp>Could DNA tests like this be the vanguard of personalized medicine? A few months ago, President Obama announced a $215 million \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/30/382659919/obama-wants-funding-for-research-on-more-precise-health-care\">precision medicine initiative\u003c/a> to collect DNA records from 1 million volunteers to develop medical treatments tailored to individual genetic makeup.\u003c/p>\n\u003cp>\"I think we aren't there yet,\" said Neidich. \"While humans have about 20,000 genes, only about 5,000 genes have been reported in the scientific literature to be associated with a disorder found in humans. We have no clue what the other ones do.\"\u003c/p>\n\u003cp>Four DNA-based drugs were just \u003ca href=\"https://personalizedmedicinecoalition.wordpress.com/2015/07/30/turning-a-corner-how-this-months-decisions-at-fda-inform-the-debate-on-drug-costs/\">approved\u003c/a> by the FDA, and in 2014, nine of the 41 FDA-approved medicines were \u003ca href=\"http://www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/2014-fda-approvals-personalized-medicine2.pdf\">personalized treatments\u003c/a>.\u003c/p>\n\u003cp>With the exception of new genetically targeted drugs for chronic hepatitis C, where patients' response depends on the genotype of their infection, all these personalized drugs treat rare diseases and unusual forms of cancer, where disease is caused by one gene or a handful of genes.\u003c/p>\n\u003cp>Health insurance companies are watching these developments like hawks. Indeed, the research arm of Kaiser Permanente, my health care plan, has been accumulating a genetic data bank to study complex conditions like heart disease and diabetes.\u003c/p>\n\u003cp>So far over 200,000 Kaiser Permanente members have contributed DNA samples to be analyzed along with their health records. This matters, because small effects are easier to detect over a large population, particularly in ethnic groups not well-represented in prior clinical trials.\u003c/p>\n\u003cp>So what can cardiac researchers conclude so far from these genetic data? \u003ca href=\"http://www.chori.org/Principal_Investigators/Krauss_Ronald/krauss_overview.html\">Dr. Ronald Krauss\u003c/a>, a lipid specialist at Children's Hospital Oakland Research Institute and the University of California, San Francisco, has been studying cholesterol metabolism for over 40 years and has been collaborating with the Kaiser study.\u003c/p>\n\u003cp>Krauss is concerned about the unseen effects of statin use over time. \"The focus on cholesterol and on relatively uncommon adverse effects of statins such as muscle damage and onset of diabetes could be the tip of the iceberg in terms of biological effects with clinical consequences for some individuals,\" Krauss said. \"These could be either negative or positive. In the lab, we see widespread effects of statins at the cellular and molecular level. Are subtle things happening that affect health over the long term?\"\u003c/p>\n\u003cp>But unlike my single gene test for muscle weakness, predicting a risk or treatment response for complex conditions like heart disease involves sifting through a dog's breakfast of genetic variants of varying impact.\u003c/p>\n\u003cp>\"It is not like \u003ca href=\"http://ghr.nlm.nih.gov/condition/huntington-disease\">Huntington's disease\u003c/a>, where a single identifiable genetic variant can give you the disease,\" said Krauss. \"In complex conditions like heart disease, there are multiple genetic effects, but for the most part, each individual genetic trait has a modest effect.\"\u003c/p>\n\u003cp>But the complications don't stop there. Other factors that can affect a person's disease risk and response to treatment include gut bacteria, RNA, acquired DNA changes, lifestyle and environment. Parsing out the impacts of these variables will require massive computing power and gargantuan data storage capacity to deal with the flood of genetic information to be sequenced and interpreted.\u003c/p>\n\u003cp>\"As we have learned more about the biology of statin response, it is clear that this involves major regulatory networks, and this is big stuff,\" said Krauss.\u003c/p>\n\u003cp>So, time for another cholesterol test. Apparently I'm prone to high cholesterol, no matter how many vegetables I ingest. At least I can experiment with Schaefer's statin recommendations until the bioinformaticians surfing the precision medicine data deluge figure out the big stuff.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://wendywolfson.wordpress.com/\">Wendy Wolfson\u003c/a>\u003cem> is a science writer in Orange County, Calif.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Are+Statins+Bad+For+Me%3F+Personalized+Medicine+Can%27t+Yet+Say&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/34452/are-statins-bad-for-me-personalized-medicine-cant-yet-say","authors":["byline_futureofyou_34452"],"categories":["futureofyou_1064"],"tags":["futureofyou_80","futureofyou_209","futureofyou_582"],"featImg":"futureofyou_34453","label":"futureofyou"},"futureofyou_1845":{"type":"posts","id":"futureofyou_1845","meta":{"index":"posts_1591205157","site":"futureofyou","id":"1845","score":null,"sort":[1429651371000]},"guestAuthors":[],"slug":"personal-treatments-for-your-unique-tumor","title":"Personal Treatments for Your Unique Tumor","publishDate":1429651371,"format":"standard","headTitle":"Contributor | KQED Future of You | KQED Science","labelTerm":{"term":172,"site":"futureofyou"},"content":"\u003cp>In a recent \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25837513\">study\u003c/a> in Science reviewed \u003ca href=\"http://news.sciencemag.org/health/2015/04/personalized-cancer-vaccines-may-fight-tumors\">here\u003c/a>, human immunologist Beatriz Carreno of Washington University in St. Louis and her coworkers have used a patient’s own immune system against their cancer cells. It is too soon to know whether the treatment can cure patients or not but the patients in the study did tolerate the treatment well and their immune systems responded appropriately.\u003c/p>\n\u003caside class=\"pullquote alignright\">“It could turn out to be chemotherapy without the hair loss and nausea.”\u003c/aside>\n\u003cp>Now this isn’t a big deal because they used the patient’s immune system to attack cancer. Heck, the prostate cancer treatment \u003ca href=\"http://en.wikipedia.org/wiki/Sipuleucel-T\">Provenge\u003c/a> has been on the market since 2010 and it uses the same idea.\u003c/p>\n\u003cp>No, what makes this approach so important is that it has the potential to become a treatment for lots and lots of different cancers. It could turn out to be chemotherapy without the hair loss and nausea.\u003c/p>\n\u003cp>\u003cstrong>Potentially Transformative and Punishingly Expensive\u003c/strong>\u003c/p>\n\u003cp>The authors in this study analyzed three different patients’ tumor cells and found a unique set of triggers for each patient that they used to activate their immune systems. Each patient received an individualized treatment tailored to their own tumor.\u003c/p>\n\u003cfigure id=\"attachment_1851\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/LungCancerCellDividing.jpg\">\u003cimg class=\"size-full wp-image-1851\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/LungCancerCellDividing.jpg\" alt=\"Each cancer cell is like a snowflake, totally unique. Scientists can exploit this uniqueness to trea cancer (Wikimedia Commons)\" width=\"300\" height=\"230\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Each cancer cell is like a snowflake, totally unique. Scientists can exploit this uniqueness to treat cancer (\u003ca href=\"http://upload.wikimedia.org/wikipedia/commons/d/d1/Lung_cancer_cell_during_cell_division-NIH.jpg\">Wikimedia Commons\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>If this all works out, there is no reason to think that a similar approach couldn’t be used for most anyone’s cancer. This study might be showing us the way to a truly personalized medicine in which each patient has their own unique treatment with minimal side effects. Or, then again, maybe not.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Even if it works, a personalized treatment like this will almost certainly be breathtakingly (or maybe more appropriately breath-givingly) expensive. The much simpler treatment Provenge costs over $100,000. A treatment based on this approach will cost even more because it is so much more complicated.\u003c/p>\n\u003cp>And there is no guarantee that it will be particularly effective either. On average Provenge gives patients an additional 4 months or so. It is possible this new treatment could be better but then again it might not be.\u003c/p>\n\u003cp>Still, the convergence of cheap DNA sequencing and a better understanding of how the immune system works has opened the door to new treatments for cancer. Even if this treatment doesn’t work, we still may use our newfound knowledge to dream up newer, more precise treatments.\u003c/p>\n\u003cp>\u003cstrong>Cancer as Other \u003c/strong>\u003c/p>\n\u003cp>We can get our immune systems to recognize tumors because cancer cells have changed so much from what they originally were that they are almost as foreign as bacteria or viruses. And our immune systems know what to do with foreign cells. They find and destroy them.\u003c/p>\n\u003cfigure id=\"attachment_1855\" class=\"wp-caption alignright\" style=\"max-width: 500px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/NormalAndCancer.jpg\">\u003cimg class=\"size-full wp-image-1855\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/NormalAndCancer.jpg\" alt=\"Cancer cells have mutated into something foreign our bodies can be trained to attack. (Wikimedia Commons)\" width=\"500\" height=\"365\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/NormalAndCancer.jpg 500w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/NormalAndCancer-400x292.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/NormalAndCancer-320x234.jpg 320w\" sizes=\"(max-width: 500px) 100vw, 500px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cancer cells have mutated into something foreign our bodies can be trained to attack. (\u003ca href=\"http://upload.wikimedia.org/wikipedia/commons/2/2b/Normal_and_cancer_cells_structure.jpg\">Wikimedia Commons\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>Unfortunately cancer cells aren’t quite foreign enough for our immune systems to recognize them on their own. This is why we need scientists to give our immune systems a gentle nudge in the right direction. They do this by using the cancer cell’s mutations against itself.\u003c/p>\n\u003cp>Cancer starts out as a cell that gets a few mutations in its DNA that cause it to either grow uncontrollably and/or refuse to die. Then, because some of these mutations also make the DNA in these cells less stable, more and more mutations happen as the cancer develops.\u003c/p>\n\u003cp>This is why each person’s cancer is unique. Each person’s cancer has a distinct set of mutations that depend on what happened to the cell’s DNA after those first few critical mutations.\u003c/p>\n\u003cp>This is also why the scientists in this study needed to create unique treatments for each patient. The three patients did not share the same set of mutations that were useful for the therapy and so could not be treated in the same way.\u003c/p>\n\u003cp>If this approach works, it could be a game changer for cancer vaccines* like this. They will be able to be used by many different patients with a wide range of cancers.\u003c/p>\n\u003cp>\u003cem>*Cancer vaccine is the current name for these treatments but it isn’t great. Vaccine implies that it will prevent the cancer from happening if you take it but it does no such thing. A better term is probably immunotherapy.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Not Your Uncle’s Cancer Vaccines\u003c/strong>\u003c/p>\n\u003cp>As I said, there is a similar product on the market, the prostate cancer treatment Provenge. With Provenge, every patient’s immune system is activated with the same prostate-cancer specific trigger. What makes it personalized is that each treatment uses a patient’s own immune cells.\u003c/p>\n\u003cp>This approach is different in that it adds an additional layer of personalization. Each patient’s cells are activated by a set of triggers unique to their particular cancer. This is a much more complicated undertaking than Provenge.\u003c/p>\n\u003cp>Scientists first need to read and compare the DNA of the cells of the patient and the cancer. Then they need to identify the key differences between the two and convert them into a set of triggers that can be used to program the patient’s immune cells to recognize the cancer cells. While this is getting cheaper and easier, it is still no picnic. It takes a lot of time and money to pull off.\u003c/p>\n\u003cp>After this part, it is pretty much the same as with Provenge. The right immune cells are removed from the patient and put in a dish. Then the immune cells are exposed to the triggers, grown up in the dish and then put back into the patient. Then, if everything is working right, the patient’s immune system seeks out and destroys any tumor cells it finds.\u003c/p>\n\u003cp>This is obviously nontrivial! But still, given how cheap DNA sequencing has become, it is certainly doable. Now we will have to wait and see if it is effective and affordable.\u003c/p>\n\u003cp>\u003cem>A lengthy but very complete description of this approach to making cancer vaccines:\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[youtube http://www.youtube.com/watch?v=da9z30QsE9k&w=480&h=360]\u003c/p>\n\n","blocks":[],"excerpt":"By turning a patient's immune system against his or her own tumor, a group of scientists has shown that a personalized treatment for many different kinds of cancer is safe. The next step will be to see if it is effective.","status":"publish","parent":0,"modified":1477282967,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1038},"headData":{"title":"Personal Treatments for Your Unique Tumor | KQED","description":"By turning a patient's immune system against his or her own tumor, a group of scientists has shown that a personalized treatment for many different kinds of cancer is safe. The next step will be to see if it is effective.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Personal Treatments for Your Unique Tumor","datePublished":"2015-04-21T21:22:51.000Z","dateModified":"2016-10-24T04:22:47.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"1845 http://ww2.kqed.org/futureofyou/?p=1845","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/04/21/personal-treatments-for-your-unique-tumor/","disqusTitle":"Personal Treatments for Your Unique Tumor","path":"/futureofyou/1845/personal-treatments-for-your-unique-tumor","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a recent \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25837513\">study\u003c/a> in Science reviewed \u003ca href=\"http://news.sciencemag.org/health/2015/04/personalized-cancer-vaccines-may-fight-tumors\">here\u003c/a>, human immunologist Beatriz Carreno of Washington University in St. Louis and her coworkers have used a patient’s own immune system against their cancer cells. It is too soon to know whether the treatment can cure patients or not but the patients in the study did tolerate the treatment well and their immune systems responded appropriately.\u003c/p>\n\u003caside class=\"pullquote alignright\">“It could turn out to be chemotherapy without the hair loss and nausea.”\u003c/aside>\n\u003cp>Now this isn’t a big deal because they used the patient’s immune system to attack cancer. Heck, the prostate cancer treatment \u003ca href=\"http://en.wikipedia.org/wiki/Sipuleucel-T\">Provenge\u003c/a> has been on the market since 2010 and it uses the same idea.\u003c/p>\n\u003cp>No, what makes this approach so important is that it has the potential to become a treatment for lots and lots of different cancers. It could turn out to be chemotherapy without the hair loss and nausea.\u003c/p>\n\u003cp>\u003cstrong>Potentially Transformative and Punishingly Expensive\u003c/strong>\u003c/p>\n\u003cp>The authors in this study analyzed three different patients’ tumor cells and found a unique set of triggers for each patient that they used to activate their immune systems. Each patient received an individualized treatment tailored to their own tumor.\u003c/p>\n\u003cfigure id=\"attachment_1851\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/LungCancerCellDividing.jpg\">\u003cimg class=\"size-full wp-image-1851\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/LungCancerCellDividing.jpg\" alt=\"Each cancer cell is like a snowflake, totally unique. Scientists can exploit this uniqueness to trea cancer (Wikimedia Commons)\" width=\"300\" height=\"230\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Each cancer cell is like a snowflake, totally unique. Scientists can exploit this uniqueness to treat cancer (\u003ca href=\"http://upload.wikimedia.org/wikipedia/commons/d/d1/Lung_cancer_cell_during_cell_division-NIH.jpg\">Wikimedia Commons\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>If this all works out, there is no reason to think that a similar approach couldn’t be used for most anyone’s cancer. This study might be showing us the way to a truly personalized medicine in which each patient has their own unique treatment with minimal side effects. Or, then again, maybe not.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Even if it works, a personalized treatment like this will almost certainly be breathtakingly (or maybe more appropriately breath-givingly) expensive. The much simpler treatment Provenge costs over $100,000. A treatment based on this approach will cost even more because it is so much more complicated.\u003c/p>\n\u003cp>And there is no guarantee that it will be particularly effective either. On average Provenge gives patients an additional 4 months or so. It is possible this new treatment could be better but then again it might not be.\u003c/p>\n\u003cp>Still, the convergence of cheap DNA sequencing and a better understanding of how the immune system works has opened the door to new treatments for cancer. Even if this treatment doesn’t work, we still may use our newfound knowledge to dream up newer, more precise treatments.\u003c/p>\n\u003cp>\u003cstrong>Cancer as Other \u003c/strong>\u003c/p>\n\u003cp>We can get our immune systems to recognize tumors because cancer cells have changed so much from what they originally were that they are almost as foreign as bacteria or viruses. And our immune systems know what to do with foreign cells. They find and destroy them.\u003c/p>\n\u003cfigure id=\"attachment_1855\" class=\"wp-caption alignright\" style=\"max-width: 500px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/NormalAndCancer.jpg\">\u003cimg class=\"size-full wp-image-1855\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/NormalAndCancer.jpg\" alt=\"Cancer cells have mutated into something foreign our bodies can be trained to attack. (Wikimedia Commons)\" width=\"500\" height=\"365\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/NormalAndCancer.jpg 500w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/NormalAndCancer-400x292.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/NormalAndCancer-320x234.jpg 320w\" sizes=\"(max-width: 500px) 100vw, 500px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cancer cells have mutated into something foreign our bodies can be trained to attack. (\u003ca href=\"http://upload.wikimedia.org/wikipedia/commons/2/2b/Normal_and_cancer_cells_structure.jpg\">Wikimedia Commons\u003c/a>)\u003c/figcaption>\u003c/figure>\n\u003cp>Unfortunately cancer cells aren’t quite foreign enough for our immune systems to recognize them on their own. This is why we need scientists to give our immune systems a gentle nudge in the right direction. They do this by using the cancer cell’s mutations against itself.\u003c/p>\n\u003cp>Cancer starts out as a cell that gets a few mutations in its DNA that cause it to either grow uncontrollably and/or refuse to die. Then, because some of these mutations also make the DNA in these cells less stable, more and more mutations happen as the cancer develops.\u003c/p>\n\u003cp>This is why each person’s cancer is unique. Each person’s cancer has a distinct set of mutations that depend on what happened to the cell’s DNA after those first few critical mutations.\u003c/p>\n\u003cp>This is also why the scientists in this study needed to create unique treatments for each patient. The three patients did not share the same set of mutations that were useful for the therapy and so could not be treated in the same way.\u003c/p>\n\u003cp>If this approach works, it could be a game changer for cancer vaccines* like this. They will be able to be used by many different patients with a wide range of cancers.\u003c/p>\n\u003cp>\u003cem>*Cancer vaccine is the current name for these treatments but it isn’t great. Vaccine implies that it will prevent the cancer from happening if you take it but it does no such thing. A better term is probably immunotherapy.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Not Your Uncle’s Cancer Vaccines\u003c/strong>\u003c/p>\n\u003cp>As I said, there is a similar product on the market, the prostate cancer treatment Provenge. With Provenge, every patient’s immune system is activated with the same prostate-cancer specific trigger. What makes it personalized is that each treatment uses a patient’s own immune cells.\u003c/p>\n\u003cp>This approach is different in that it adds an additional layer of personalization. Each patient’s cells are activated by a set of triggers unique to their particular cancer. This is a much more complicated undertaking than Provenge.\u003c/p>\n\u003cp>Scientists first need to read and compare the DNA of the cells of the patient and the cancer. Then they need to identify the key differences between the two and convert them into a set of triggers that can be used to program the patient’s immune cells to recognize the cancer cells. While this is getting cheaper and easier, it is still no picnic. It takes a lot of time and money to pull off.\u003c/p>\n\u003cp>After this part, it is pretty much the same as with Provenge. The right immune cells are removed from the patient and put in a dish. Then the immune cells are exposed to the triggers, grown up in the dish and then put back into the patient. Then, if everything is working right, the patient’s immune system seeks out and destroys any tumor cells it finds.\u003c/p>\n\u003cp>This is obviously nontrivial! But still, given how cheap DNA sequencing has become, it is certainly doable. Now we will have to wait and see if it is effective and affordable.\u003c/p>\n\u003cp>\u003cem>A lengthy but very complete description of this approach to making cancer vaccines:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/da9z30QsE9k'\n title='//www.youtube.com/embed/da9z30QsE9k'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/1845/personal-treatments-for-your-unique-tumor","authors":["6177"],"series":["futureofyou_172"],"categories":["futureofyou_1060"],"tags":["futureofyou_103","futureofyou_208","futureofyou_80","futureofyou_209"],"featImg":"futureofyou_1848","label":"futureofyou_172"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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