Introduction
The IGSP focuses on improving lung cancer treatment through better knowledge of tumor biology. Together with Duke Comprehensive Cancer Center and the Division of Medical Oncology at the Duke University Medical Center, the IGSP has created a clinical trials program where new scientific discoveries are part of clinical trials.
Our goal is to give doctors tools to determine if a tumor will respond to a particular treatment and identifying tumors more likely to recur. Focusing on tumor biology, the IGSP can match genetic and genomic changes in lung cancer to how a tumor behaves. Our initial studies show that treatment response and recurrence risk is connected to genomic changes in non-small cell lung cancer tumors. Our hope is that in the future doctors can use genomic information to choose the best treatment for an individual patient, leading to personalized (individualized) lung cancer treatment.
Non-Small Cell Lung Cancer
Lung cancer is the third most commonly diagnosed cancer and causes most cancer deaths. More than 200,000 men and women are diagnosed with lung cancer each year. About 160,000 people die from the disease each year.
The two main types of lung cancer are Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung cancer (NSCLC). Researchers at the IGSP are currently concentrating on NSCLC.
About 9 in 10 lung cancers are NSCLC. There are several types of NSCLC. Each type grows and spreads in different ways and each is characterized by different kinds of cancerous cells.
It is difficult to detect lung cancer early. Early detection is not part of any treatment guidelines but lung cancer screening is being studied in clinical trials. Treatment decisions are mainly based on the extent to which the cancer has metastasized; that is, how much it has spread throughout the body. "Staging" is the process of finding out whether cancer has spread within the lungs or to other parts of the body.
Doctors measure a patient's risk from NSCLC by tumor size and if it has spread. The risk is higher if the cancer has spread to the lymph nodes or to distant organs. Based on the stage of cancer, doctors will decide on a treatment for NSCLC. They may recommend surgery, radiation, chemotherapy or a combination of these.
One of the reasons it is tough to treat cancer is that we cannot predict which patients will respond to a type of treatment. It is also hard to predict which tumors will recur. Our research at the IGSP is focused on finding out which patient will respond to chemotherapy and which tumors will recur. Our approach is to characterize the unique features of each patient's tumor. Such information helps doctors take a highly directed approach to treatment that allows therapy to be targeted to each patient's tumor. This targeting makes the treatment more likely to treat the tumor successfully.
Genes, Cells, & Cancer
The human body is built from millions of cells. Inside each cell is DNA, the inherited genetic material that programs cell growth and development. DNA is organized into genes. Each gene contains the information for a specific task carried out by the cell. Genes represent the "blueprint" for all processes of the human body. The collection of all our genes is called the genome. Scientists estimate that the human genome contains 20,000 to 25,000 genes. Although each cell contains a full set of genes, not all of the genes are active at the same time. Some genes are turned 'on' and others are turned 'off' at different times. When genes are turned 'on' they are copied into RNA. We can measure the amount of RNA in a group of cells (such as a tumor) to assess which genes are turned 'on' (expressed) or 'off' (not expressed).
It is possible for genes to become damaged or changed over time. Damaged genes can result in cells that no longer act the way they should. For example, the genes that stop a cell from multiplying might become damaged. If a cell is unable to stop multiplying, it will keep on multiplying and may lead to a tumor. There are many changes that can lead to a cell's ability to grow out of control and become a tumor. It is possible that a cell can have changed gene expression (RNA level) that can result in a tumor.