Bring on the Biomarkers!

I have pinched this title from a slide shown by Charlie Swanton at the First London Cancer Breast Study Day earlier this week! He was one of about a dozen speakers and his session was on a personalised approach to breast cancer treatment. Back to last year's theme of stratified medicine.

He was making the point that predicting drug response and the whole issue of multi-drug resistance are some of the challenges of the personalised approach. The genomics revolution makes it possible to make treatment or trial eligibility decisions fairly quickly based on sequencing from a single biopsy sample. But there is a question as to whether this is the best approach.

Looking at mutations found in samples from primary and secondary tumours shows that while some are ubiquitous, many are not; in fact, the majority are not. Intra-tumour heterogeneity means that drug response can't always be predicted from the sequencing of a single sample.

All this, he suggested, means that the traditional model of linear evolution of cancer is not helpful. Instead, tumours and their evolution are more like trees with branches going off in different directions and then themselves branching. Some tumour-trees have long trunks, while in others the branching starts much lower down. This goes some way to explaining why sometimes we don't see the expected response to a particular drug.

Another reason why stratified medicine is so important.

The Light and The Dark

A major difficulty with life here in the Land of New Normal is that even while I'm counting out my reasons to be cheerful there comes difficult news.

Over the last few weeks we have lost two of our international bloggers and, more recently and closer to home, one of the North East girls to this horrible disease.  And still close to home there has been bad news for a couple more.

Life seems somehow sharper here. The sadness surrounding the losses and grim news is painfully deep. But the breath-taking beauty of a morning drive past the diamond-sparkly frost-on-snow fields, hedges and trees the weekend before last was certainly heightened. The friendships that we form in this sisterhood that was thrust upon us are precious and life-giving, but when those very friends are taken from us the grief is profound.