3 ms·

I mean most cancer is still diagnosed and treated in a "classical" manner. I doubt he'd deny it genomics has massive potential in oncology.

by ryan93 3y ago

biotinker 3y ago
> most cancer is still diagnosed and treated in a "classical" manner. This is half-true at best. As someone who's helped build FDA-approved genomic tests for cancer treatment, a huge proportion of cancers (in the US) are treated by sequencing and informing treatment based on sequence results. Especially among stages 3 and 4. Diagnosis of early-stage (1 & 2) cancer via genomics is a difficult problem, because when the cancer is small, so is the amount of DNA it gives off. Liquid biopsy tests have a lot of trouble reliably distinguishing that small signal from noise, and it's not really cost-effective to test every single person for stage 3+ cancer via blood tests on a regular basis. Treatment of some early-stage cancers can suffer from the same problem, where it can be difficult to obtain a sufficient sample of cancer genetic material. But the treatment landscape for late-stage cancers looks utterly different than it did 20 years ago. The idea that most stage 4 cancer is still treated in a "classical" manner in the US is patently false.
epistasis 3y ago
Genomics doesn't merely have massive potential, it's the backbone of research in cancer, even if the diagnostics are slimmed down to simple PCR tests or to even antibody staining on a slide, or to assigning drugs. In some of the big cancers, sequencing is even a primary diagnostic: * breast cancer: gene expression signatures are standard for determining the necessity of chemo * colon: blood based sequencing for KRAS mutation is extremely common * lung: matching kinase inhibitors to EGFR mutations is essential for therapy * all solid tumors: tumor mutation burden is a companion diagnostic for the major immune checkpoint therapies that have revolutionized treatment over the past decade. I know of almost no cancer that has not had massive changes in treatment, due to accelerated research possibly only through extensive use of genomics.
- sungam 3y ago
  We also test melanomas for BRAF mutations
f6v 3y ago
There’re many targeted oncology panels on the market, whole exome sequencing is getting more widespread in developed counties. These inform clinical decisions today, not in the future.

I mean most cancer is still diagnosed and treated in a "classical" manner. I doubt he'd deny it genomics has massive potential in oncology.

by ryan93 3y ago

I mean most cancer is still diagnosed and treated in a "classical" manner. I doubt he'd deny it genomics has massive potential in oncology.

biotinker 3y ago

> most cancer is still diagnosed and treated in a "classical" manner. This is half-true at best. As someone who's helped build FDA-approved genomic tests for cancer treatment, a huge proportion of cancers (in the US) are treated by sequencing and informing treatment based on sequence results. Especially among stages 3 and 4. Diagnosis of early-stage (1 & 2) cancer via genomics is a difficult problem, because when the cancer is small, so is the amount of DNA it gives off. Liquid biopsy tests have a lot of trouble reliably distinguishing that small signal from noise, and it's not really cost-effective to test every single person for stage 3+ cancer via blood tests on a regular basis. Treatment of some early-stage cancers can suffer from the same problem, where it can be difficult to obtain a sufficient sample of cancer genetic material. But the treatment landscape for late-stage cancers looks utterly different than it did 20 years ago. The idea that most stage 4 cancer is still treated in a "classical" manner in the US is patently false.

epistasis 3y ago

Genomics doesn't merely have massive potential, it's the backbone of research in cancer, even if the diagnostics are slimmed down to simple PCR tests or to even antibody staining on a slide, or to assigning drugs. In some of the big cancers, sequencing is even a primary diagnostic: * breast cancer: gene expression signatures are standard for determining the necessity of chemo * colon: blood based sequencing for KRAS mutation is extremely common * lung: matching kinase inhibitors to EGFR mutations is essential for therapy * all solid tumors: tumor mutation burden is a companion diagnostic for the major immune checkpoint therapies that have revolutionized treatment over the past decade. I know of almost no cancer that has not had massive changes in treatment, due to accelerated research possibly only through extensive use of genomics.

sungam 3y ago
We also test melanomas for BRAF mutations

f6v 3y ago

There’re many targeted oncology panels on the market, whole exome sequencing is getting more widespread in developed counties. These inform clinical decisions today, not in the future.