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As Unique as You

Tailoring cancer treatments to your DNA
Cancer is a fairly inclusive disease. It affects millions of people across the board with no partiality to age, ethnicity, gender or social class. And although it has become a very common thing to have cancer, the cause and effects of each person’s disease is solely unique to them.

One-size-fits-all treatment is making way for more personalized care as scientists and doctors learn more about genomics and the part they play in cancer.

“This is a very evolving field,” says Anu Gaba, MD, medical oncologist at Sanford Roger Maris Cancer Center. “There are many different ways in which we can apply the knowledge we have about a person’s DNA in order to offer them better care.”

Predisposed for cancer
While scientists are still learning about the intricacies of the human genome, certain genes have proven to be good indicators for the possibility of cancer.

“We look to identify those genes that might make you predisposed to cancer,” says Dr. Gaba. “We do a risk assessment. We look at family history, the age of diagnosis, the severity of the disease. We will have our patients meet with a genetic counselor who will go over your family tree and decide which genes need to be tested.”

Dr. Gaba explains that two of the most well-known genes associated with cancer are BRCA 1 and BRCA 2. Having an abnormality in these genes increases, but not guarantees, your chance of developing breast cancer. Having this information can help doctors and patients be more proactive about their care.

“If we know you have these mutations, then we can implement earlier screenings,” explains Dr. Gaba. “We may suggest that you start mammograms and self-breast exams earlier than we would have if those genes were normal. We know, we test, we institute measures and we catch it early or prevent the cancer from occurring.”

Personalized treatment plan
As testing genes for a predisposition to cancer continues to grow, those currently with cancer can also benefit from these tests.

Understanding the science behind why certain cells mutate can help dictate the type of treatment patients receive.

“Ten years ago, everyone received the same medication, the same treatment,” explains Dr. Gaba. “That’s not the case anymore. We can tailor our therapy to the individual and improve the outcome.”

Dr. Gaba explains when a tumor is removed or when a biopsy is done, it is tested. The test looks for genetic changes in the tumor and from that a risk score is produced. If there is a low risk, doctors can prescribe anti-hormonal therapy alone, without the need for chemotherapy. If the risk is higher, they can administer .

“If we know that we can treat a patient with fewer drugs, then we are going to do that,” states Dr. Gaba. “We don’t want to be giving them any more of these toxic drugs than what they need.”

Together as a team
These decisions of testing and treatment are made with input from a number of sources, including the patient.

“We always sit down and talk with the patient,” says Dr. Gaba. “It’s important that they understand the approaches we want to take and why.”

These treatment approaches are based on conversations had at weekly tumor board meetings. Surgeons, radiation teams, pathologists and a number of other team members meet to discuss every patient’s situation, review scans and test results, and decide on the best treatment plan.

“This gives anyone a chance to have input,” says Dr. Gaba. “It opens up a good, healthy discussion and ensures that nothing is overlooked.”

New clinical trial
Dr. Gaba is taking this personalized approach to cancer medicine and is using it as the basis for an upcoming clinical trial. The trial is comprised of 50 patients with incurable metastatic cancer who have already gone through chemotherapy from Fargo and Sioux Falls. Blood and tumor samples will be taken and genetic testing will be done. However these tests will be more extensive.

“Normally we are testing 1-21 genes,” explains Dr. Gaba. “For this trial, we are testing for more than 200 different changes in the DNA.”

Based on the findings, Dr. Gaba and her team will recommend treatment for each individual.

“We are tailoring their care and treatment to their specific tumor,” says Dr. Gaba. “Hopefully this will result in better outcomes than just chemo alone, and I really feel like we are moving in the right direction.”

To make an appointment with Dr. Gaba, call the Roger Maris Cancer Center at (701) 234-6161.

Posted Date: June 2014