The Challenge and Opportunity in Developing Personalized Cancer Therapy

January 03, 2011
Lebanon, NH

Robert C. Bast, Jr., MD

Building on the decoding of the human genome and major advances in bioinformatics, personalized therapy has the potential to revolutionize medical treatment, especially cancer treatment. Difficult challenges still must be overcome, however, before "the right treatment for the right person at the right time" becomes standard practice, stated Robert C. Bast, Jr., MD, in his December 2, 2010 lecture at Norris Cotton Cancer Center.

Dr. Bast, who is vice president for translational research and the Harry Carothers Wiess Distinguished University Professor for Cancer Research at the University of Texas M.D. Anderson Cancer Center, delivered the 33rd Annual David B. Kaner Memorial Lecture.

According to Dr. Bast, cancer in particular presents challenges for personalized treatment. "The problem is that we're dealing with an incredibly heterogeneous set of diseases that develop at more than 100 different sites," he said. "Also, given the genetic differences between patients with cancer, I think it's safe to say that no two cancers are exactly alike."

In his presentation, titled "Challenges Facing Translational Research in Personalizing Cancer Care," Dr. Bast said that despite the challenges, the future is bright with possibilities. "In the last two decades, I think we've begun to come to terms with just how complex cellular biology is - looking at the human genome with 25,000 distinct genes, looking at more than 250,000 species of coding and non-coding RNAs, as well as 2-8 million species of proteins," he noted. Such complexity, Bast said, means that "we now stand at biology where the geographers stood in the year 1500. They understood that there were new continents across the oceans, but they had no idea of their shape and size."

Another challenge in understanding the geography of personalized therapy is managing the data generated by genome sequencing. "If you look at the amount of data that's generated by deep-sequencing just one specimen, it's on the order of 250,000 gigabytes," Bast said. Data storage of this magnitude has become an international challenge. Moreover, "the analysis of data has really gone beyond the experience of most molecular biologists and physician-scientists," he commented. "We need to bring many more computer scientists, bio-informaticians, and computer-modelers into systems biology. And we also need more math taught to physician-scientists."

At the same time, because of new knowledge of the human genome, "The cost of sequencing cancer is halving every five months," he pointed out, "and within the decade, sequencing the entire genome of a cancer could cost less than $1,000."

While many of the mysteries of cancer have been unraveled in laboratories, Dr. Bast commented, "Our progress in the clinic has been real but much more gradual. The challenge for translational research over the next years is to make our progress in the clinic look much more like our progress in the laboratory."

He added: "We need to invest in trials and infrastructure for sequencing, testing, and developing pathway-centered and organ-focused approaches in the laboratory, and we need to establish, sustain and retain translational teams that include not only physician-scientists and clinician investigators, but molecular imagers, molecular pathologists, translational scientists, pharmacists, biostatisticians and bioinformaticians, research nurses and data managers, and experts in regulatory affairs."

But he remains optimistic that the challenges will be overcome. "I think we're going to see more effective, less toxic therapy, and earlier detection and prevention developed where we identify the risk and the benefit for each individual patient with much greater precision as well as to understand the biology of their disease," he concluded.

The David B. Kaner Memorial Lecture was established at Dartmouth Medical School in 1974 in memory of David B. Kaner, MD, by his loving family and friends. The lectureship brings distinguished guest lecturers in the fields of surgery and oncology to the Medical School each year, thereby expanding the body of knowledge of students, faculty, and the community at large.

About Dartmouth-Hitchcock Norris Cotton Cancer Center

Norris Cotton Cancer Center combines advanced cancer research at Dartmouth College and Dartmouth Medical School with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester and Keene, NH, and St. Johnsbury, Vt., and at 11 partner hospitals throughout New Hampshire and Vermont. It is one of 40 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at

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