THE NICHOLAS CONOR INSTITUTE Curing Kids Cancer Through Collaboration
The Nicholas Conor Institute provides leadership in the development of better diagnostic tools and companion treatments for childhood cancer. This is Personalized Medicine; providing and adapting treatments so that they are specific to the individual child and that child's cancer. The tools that allow for this approach are those of genomics and proteomics.
Genomics and Proteomics
In the last 10 years the human genome has been decoded and this has revealed that Humans have somewhere between 20,000 and 30,000 individual genes. Every cell in the body houses the entire genome, yet only a small subset of our total number of proteins are expressed in each cell type. Genomics is the study of the genome and all of those genes, whereas Proteomics is the study of the proteins encoded by all of the genes.
Humans are a diverse group and each person has a slightly different genome that is unique to them. Because of this, they also have a slightly different and unique Proteome. Using Genomics we can map the genes of a specific person and take what amounts to a genetic photograph. Just like a real photograph, this accurately represents one person. Similarly, using Proteomics we can map out the various proteins expressed in different cells, tissue and organs.
"We have traditionally treated children, adolescents and young adults with cancer on cooperative-group protocols which has contributed significantly to improved outcomes during the latter part of the 20th century. However, this approach has not taken into consideration individual characteristics of the patient's tumor nor equally importantly, of the child's ability to tolerate the various chemotherapeutic agents, radiotherapy and immunotherapy prescribed.
We are moving forward in the 21st century with an increasing ability to understand the signalling pathways involved in tumorigenesis as well as each patient's unique ability to metabolize and tolerate treatments.
I feel strongly that a more personalized approach to diagnosis, prognosis, risk stratification and treatment planning as well as long term follow-up for late effects will ultimately result in significantly improved outcomes and decreased toxicity. The Nicholas Conor Institute is committed to this more personalized approach to the management of childhood cancer."
-Jennifer Willert, MD
Division of Hematology/Oncology
& Bone Marrow Transplant,
Director of Pediatric Palliative
& Supportive Care Program
Rady Children’s Hospital , San Diego
We continually replace many of the cells within our bodies, so our genome is continually being copied and packaged into those new cells. Sometimes mistakes are made during the replacement process and these mistakes are transmitted to the copied DNA. Environmental factors can also cause mistakes to occur within our DNA, so during our lifetimes we accumulate a significant number random mistakes. For most people this is a benign process. However, in some cases the random errors occur in important places within the genome and the result of this may be uncontrolled cell growth, leading to cancer. Because of the accumulation of errors in our DNA, adult cancer is usually found later in life, within the few cell types that grow and divide most often. This is not the case with childhood cancer.
Children and Cancer
Children are still developing and have a great deal of cell growth that adults do not, so anti-cancer drugs or radiotherapy can affect changes in both the cancer and the many areas of normal active growth and development. Around 60% of the children that survive cancer will develop a chronic health condition and after 30 years roughly 40% will have a life-threatening or even life-ending chronic health condition. Additionally, the survivors have a significantly increased risk of developing a second type of cancer. This is thought to be a direct result of a child`s initial cancer treatment.
What we need is a way to minimize the undesirable effects of chemotherapy or radiotherapy on children and maximize the specificity of the treatment. The emerging field of cancer genetics aims to describe the differences between the patient’s normal genetic material and that of the cancer. This information can then be used to guide oncologists and to generate more effective treatments. This is the essence of Personalized Medicine.
This new paradigm of personalized medicine attempts to change cancer treatment as it currently exists and move away from a one-size-fits-all approach. Personalized cancer treatment plans to use data that specifically describes the differences between the patient and the tumor from both genomic and proteomic standpoints. Oncologists may then select an appropriate treatment that is likely to be the most effective in destroying the specific tumor, while being least harmful to the patient. This is an especially important approach to take when treating childhood cancer.
Personalized medicine is the future of medicine and much research remains to be done to allow its translation into better treatments. The Nicholas Conor Institute aims to be at the forefront of personalized medicine for children, leading to new and far more effective treatments for childhood cancer while exhibiting far fewer side effects and a much higher quality of life, both during- and post-treatment.
THE NICHOLAS CONOR INSTITUTE 3525 Del Mar Heights Road, #946•San Diego, California 92130
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