Last month, the clinicians and researchers that make up The Cancer Genome Atlas published a breakthrough report on the “Comprehensive molecular characterization of clear cell renal cell carcinoma”. The Cancer Genome Atlas (TCGA) is an organized project sponsored by the U.S. National Institutes of Health aiming to understand the types of molecular (=genetic, DNA-based) changes that cause a person to develop cancer, and it is an international project coordinating the work of hundreds of scientists. This new report, which includes contributions from the Fox Chase Cancer Center Cancer Biology Program, gives the first details on the gene level changes and alterations that occur to cause clear cell type renal cell carcinoma, which is the most common and most aggressive type of kidney cancer.
Kidney cancer, although curable when detected early, is the most lethal and dangerous cancer of the urinary system. Even though surgery for isolated kidney cancer is highly successful, few patients are cured once kidney cancer spreads. While a large number of newer medical treatments have become available since 2005 (targeted therapy), the average benefit of these latest treatments adds only a few months of life to patients, and unfortunately, not years. While these new drugs have been important developments, they have an obvious limitation: the “targeted therapy” is only addressing one part of a cancer’s abnormality, and cancer has hundreds of changes and irregularities that go untreated. The excitement about this TCGA effort giving new information about clear cell kidney cancer, is it will lead the way to finding new approaches and therapies, by revealing the previously unknown gene defects that lead to kidney cancer occurring and spreading.
The ideal for the future of medicine, especially in treating cancer, is applying “precision medicine”, where each patient’s unique and specific genetic abnormalities can be deciphered, and then a personalized and individual “cocktail” of customized therapy can be created. Precision medicine based cancer treatment should be effective, since we will know and then can correct each patient’s unique set of genetic changes, and also safe and with few side effects, since drugs can be used that only have an effect on the altered and defective cells, and using traditional toxic chemotherapy, that also harms and damages normal cells, can be avoided. The TGCA report shows what genes are important for most cases of kidney cancer; for an individual patient, assessment by the Fox Chase Cancer Center Cancer Genome Institute can perform a similar analysis, and may similarly suggest new treatment options that are beyond the routine. While we still have several big steps ahead of us in seeing precision medicine a reality, this latest scientific advance brings us closer to that for patients with kidney cancer.