Sunday, September 16, 2012

The High Price of Tailored Cancer Treatment

I recently read Walter Isaacson’s biography of Steve Jobs. He reveals in the book that when his doctors diagnosed Jobs with cancer, he paid for an expensive and extensive analysis of his DNA to determine exactly what type of chemotherapy would correspond precisely to the variety of cancer he had. Until I read about this in the Jobs biography, I did not know about this dimension of cancer treatment. Not all cancer treatment drugs are made equal. Usually when a person receives chemo, they receive a cocktail of standard chemo drugs that attempt to cover a wide spectrum of cancer cells. This chemo blitz is hard on the body and is one of the reasons why people become so sick from the chemo itself. Every person with cancer does not receive a mix of chemo/drugs tailored to his or her unique body and specific cancer because it costs a fortune to pay for the research to identify which chemo/drug to use, based on the person’s DNA.

I recently read an article about genetic researchers in St. Louis who made a commitment to attempt to identify the gene that was causing one of their own to suffer from lymphoblastic leukemia. A beloved colleague, a young doctor who had been working on the genetic research project, was diagnosed with lymphoblastic leukemia and the rest of the team determinedly set out to investigate the complete genetic makeup of him and his cancer. They fully sequenced the genes of both his cancer cells and his healthy cells for comparison. They also analyzed his RNA. They set aside their work on the human genome (the research project they had all been working on) and they ran a sequencing machine and a supercomputer 24/7 for six months. They found the rogue gene causing the doctor’s cancer; a gene that had gone haywire and was manufacturing large amounts of a protein that was feeding the cancer’s growth. So they treated the doctor with a selected drug that was highly likely to shut down the malfunctioning of this particular rogue gene. And it worked and now the doctor’s cancer is in remission.

I certainly rejoice that a man’s life was saved, but I also feel enraged. Even though the genetic analysis and tailored chemo program that Jobs bought did not save his life, it was more likely to have done so than any other approach. Also, the chemo Jobs underwent was the easiest on his system of any treatment he could have received because it was exactly matched to his cancer and not just a wash of chemo products thrown at the disease. The young doctor benefitted from the same type of research and the same treatment approach. It angers me that every single person who contracts cancer cannot access this state-of-the-art treatment that Jobs received, or that the young doctor in St. Louis received. Why? Only because it costs too much money. And so now we get down to it. The value of human life.

Medical researchers have confirmed that it is not the person’s tissue or organ (i.e., liver, brain, bone marrow, blood, intestine) where the cancer originates that drives a cancer but rather the person’s genes. Cancer treatment is most effective when it is tailored to the exact aberrant genes causing the disease. Thus, one woman’s breast cancer may have completely different genetic drivers from another woman’s breast cancer, and each needs to be treated with a completely different chemo/drug. This method of figuring out precisely which genes have gone whack and treating cancer based on that analysis is called “whole genome sequencing,” and it is presently not available to the everyday Joe. It is also not paid for by any insurance company. Only someone as wealthy (and well-connected) as Jobs could afford to pay for whole genome sequencing. Isaacson disclosed that it cost Jobs $100,000 for the sequencing and analysis of his genes to isolate those causing his cancer.

Medical researchers speculate that it will take at least another ten years before whole genome sequencing will be made available to most patients rather than just the wealthy few. When do you reckon that insurance companies will agree to pay for this at $100,000 a pop? Makes me wanna holler.

No comments: