Patients’ Genes Seen as Future of Cancer Care

Joshua Bright for The New York Times

Dr. Laurie Glimcher, dean of Weill Cornell Medical College, visiting the new Belfer Research Building.

Electric fans growl like airplanes taking off and banks of green lights wink in a basement at Mount Sinai's medical school, where a new $3 million supercomputer makes quick work of huge amounts of genetic and other biological information.

Just a couple of miles away, a competitor, Weill Cornell Medical College and NewYork-Presbyterian Hospital/Weill Cornell hospital are building a $650 million research tower. Across the street is a newly completed $550 million tower housing labs for another competitor, Memorial Sloan-Kettering Cancer Center.

Major academic medical centers in New York and around the country are spending and recruiting heavily in what has become an arms race within the war on cancer. The investments are based on the belief that the medical establishment is moving toward the routine sequencing of every patient's genome in the quest for "precision medicine," a course for prevention and treatment based on the special, even unique characteristics of the patient's genes.

Among other projects, Harvard Medical School has its Center for Biomedical Informatics, which among a broad array of approaches uses mathematical modeling to predict when genetic information could lead to more effective treatment. Phoenix Children's Hospital opened the Ronald A. Matricaria Institute of Molecular Medicine in December, recruiting researchers from Los Angeles and Baltimore and planning to sequence the genomes of 30 percent of their childhood cancer patients in their search for better therapies.

Johns Hopkins, with its focus on public health, wants to develop a "systematic genomic sequencing program" over the next two years that will combine genomic analysis with a patient's environmental exposure, family history and other factors to support preventive medicine, said Scott Zeger, vice provost for research.

"There will be a moment in time when whole genome sequencing becomes ubiquitous throughout health care," said Peter Tonellato, director of the Harvard personalized medicine lab and a clinical investigator in pathology at Beth Israel Deaconess Medical Center in Boston. "Let's say we figure out all the individuals who might have a cancer, and we can predict that with a relatively high level of accuracy. Then presumably we can take steps to avoid those, let's say, decades of treatment."

Sequencing an entire genome currently costs in the neighborhood of $5,000 to $10,000, not including the interpretation of the information. It is usually not reimbursed by insurance, which is more likely to cover tests for genetic mutations that are known to be responsive to drugs. The treatments themselves, which are sometimes covered, typically cost several times that.

Even optimists warn that medicine is a long way from deriving useful information from routine sequencing, raising questions about the social worth of all this investment at a time of intense fiscal pressure on the health care system.

"What's the real health benefit?" said Dr. Robert C. Green, a Harvard professor and a medical geneticist at Brigham and Women's Hospital in Boston. "If you're a little bit cynical, you say, well, none, it's foolish."

Dr. Green is part of a federally sponsored research project that is looking at the economic and medical impact of whole genome sequencing. "One of the most prominent downsides is you start chasing risks for a whole lot of disease you'll never have, and generate a lot of cost for little benefits," he said.

He was not ready to dismiss the efforts of Mount Sinai and others, though. "The other side of the question is, what was there to look up on the Internet when the first person got a personal computer? Very little."

The race entails large sums spent not only on construction and technology but also recruitment, salaries and incentives for scientists like Weill-Cornell's Dr. Lewis Cantley, who was lured from Harvard, or Eric E. Schadt, plucked from the biotech world to head the Mount Sinai Institute for Genomics and Multiscale Biology.

NewYork-Presbyterian/Weill Cornell announced a new Institute for Precision Medicine, headed by a prostate cancer expert, in January. (The newly fashionable term "precision medicine" is an updated version of another genomics buzzword, "personalized medicine.") "I am not in this for competition," said Dr. Laurie Glimcher, dean of Weill Cornell Medical College. "I consider it collaboration, and I think we all have the same goal in mind, which is to cure disease."

As Weill Cornell was courting Dr. Cantley, Memorial was pursuing another Harvard eminence, Dr. José Baselga, to be its physician in chief. "It's a small world," Dr. Baselga, a breast cancer specialist, said, recalling that he and Dr. Cantley had exchanged notes on what each was being offered.

Memorial sequenced 16,000 tumors last year, mainly in lung cancer patients, Dr. Baselga said. In addition to the research building just completed on East 68th Street, a new outpatient building on East 74th Street, to be finished in 2018, will have whole floors dedicated to early-phase clinical trials.

The promise of whole genome sequencing can be seen in trials like one for bladder cancer at Memorial, where the effects of a drug normally used for breast cancer were disappointing in all but one of about 40 patients, whose tumor went away, Dr. Baselga said. Investigators sequenced the patient's whole genome. "The patient had a mutation in one gene that was right on the same pathway as the therapy," Dr. Baselga said. "And that explained why this worked."

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