Oncogenomics: The Future of Cancer Care analyzes the key advances and challenges associated with translating research efforts into successful, clinically meaningful therapeutic products. The emergence of oncogenomics promises a new era of cancer care. Over the next decade or so, biomedical researchers hope to have fully catalogued all genetic alterations associated with cancer, greatly expanding the number of “druggable” anticancer molecular targets.

Oncogenomics has already seen clinical and market success with a handful of “first-generation” oncogenomic therapeutics such as Herceptin, raising hope and expectations that safer and more effective patient-selected targeted therapeutics will revolutionize cancer therapy and transform cancer into a manageable chronic disease. While patient-selected genomic-based therapy has only recently emerged as a viable clinical practice, many experts argue that it will become crucial not just in clinical practice but as an integral component of targeted drug development.

However, despite the early success stories of Herceptin and Gleevec, many leaders in the field are cautious about the extent to which genomics will truly impact cancer care over the next 10 to 15 years. Employing the right tools, technologies, and strategies will be crucial to realizing the clinical and marketplace opportunities stemming from the burgeoning growth of oncogenomics. Oncogenomics: The Future of Cancer Care offers insightful evaluation of the following key challenges to achieving this goal and examines current approaches to addressing these issues:

• Preclinical drug candidate screening needs to be more predictive in order to increase the chance that a targeted drug entering clinical trials will succeed.

• Patient selection needs to be integrated into targeted drug development and clinical practice.

• Many pharmaceutical companies remain resistant to the patient-selected targeted drug model.

• Not all of the targets yielded by the Human Genome Project are “druggable” and it is extremely difficult to determine which genes associated with cancer are consequences, not causes, of cancer.

• Most tumors involve multiple mutations, which could translate into multiple pathways.

This report also:

• Evaluates important questions about the potential medical and revenue benefits of targeted cancer drugs that are not being realized.

• Provides an overview of the early success stories of patient-selected targeted therapeutics and highlights promising targeted therapeutics in development.

• Explores the scientific arguments for patient-selected clinical development, discusses the disincentives and challenges to patient-selected therapy, and examines the economics of patient-selected trials.

• Highlights key technologies used to discover cancer-associated genetic variation and gene expression patterns, and discusses the way in which the tools and technologies advanced by the HGP have improved this discovery process. Some of the key in vitro and animal model technologies being used to functionally test and “validate” (i.e., preclinically) these discoveries are summarized.

About the Author

Leslie A. Pray, Ph.D., is a geneticist, writer, and independent consultant. She prepares policy reports for the Board on Global Health at the National Academy of Sciences and has written extensively on a range of genetic, biotechnology, infectious disease, biomedical, and public health issues for The Scientist, Genomics and Proteomics, Orion, the American Chemical Society, the American Association for the Advancement of Science, Oak Ridge National Laboratory, and the CBR Institute for Biomedical Research, among others. Dr. Pray received her Ph.D. in population genetics from the University of Vermont and her B.A. degree from the University of California, Berkeley. She has been the recipient of numerous scientific research awards, including an American Society of Naturalists Young Investigator Award. Dr. Pray can be reached at lpray@nasw.org.