What is precision oncology?
Therapies for cancer have traditionally been based on the tumor site, like breast cancer or lung cancer. More recently, researchers have found that cancers across tumor sites have common genetic mutations – changes within the DNA of a cell – and those mutations can be targeted with specific drugs.
Precision oncology goes beyond looking at cancer by tumor site, using genetic sequencing to uncover a patient’s specific tumor mutations and deliver personalized therapies. While the field of precision oncology has advanced in recent years, we do not even know all of the cancer-causing genetic mutations or have identified therapies that can treat them.
A 360-degree approach to precision oncology
The Columbia Precision Oncology Initiative (CPOI) attacks cancer from all sides — using cutting-edge genetic sequencing, computational models that help physicians understand each patient’s unique cancer, access to the latest treatments such as immunotherapy, and world-class multidisciplinary teams that deliver the top care to our patients.
The power of predictive mathematics
Researchers at the HICCC have turned cancer research on its head. Rather than targeting each possible pattern of genetic mutations that drives cancer, they’re honing in on the network of proteins that are crucial for keeping cancer alive. Mathematicians and computational biologists in Columbia’s Department of Systems Biology have developed algorithms to predict and prioritize drugs and drug combinations, based on these complex models of cell networks, that will most effectively kill cancer cells.
Using this network approach, we’ve launched a new kind of RNA-based clinical trials, called “N-of-1 trials.”
Conducted in one patient at a time, N-of-1 clinical trials explore different treatment options based on each patient’s unique genetic makeup and cancer biology. Using methods developed in our labs, our N-of-1 clinical trials aim to identify the specific genetic and molecular factors that are key to each patient’s cancer, and to find the right therapies to stop the cancer.
Going beyond next-generation sequencing
Next-generation sequencing has provided the foundation for precision medicine. These new tests allow researchers and physicians to look at the building blocks of DNA and identify mutations of many genes at once. CPOI will go beyond next-generation sequencing to use the most advanced genetic testing, innovative RNA-based biomarkers and diagnostic tests developed here at Columbia.
Where DNA is the book that stores information about each person’s genetic expression, RNA is the reader that decodes it. RNA is more complex and can provide a deeper view into a patient’s genome, allowing researchers and physicians to identify more precise targeted treatments for each patient.
From the bench to the bedside, and back again
Taking all of the personalized data for each patient, a team of precision oncology clinical experts work together to identify the best treatment options. Oncologists, pathologists, surgeons, radiologists, immunologists, genetic counselors and others come together at weekly molecular tumor boards to review each patient’s case and the newest potential treatments.
Using samples from the patient’s tumor, researchers develop personalized tumor models to test each therapy option to find the most effective one. Once a patient and their team decide on the right treatment, they are closely monitored by the care team and researchers.