Personalized Medicine: Profiling Cancer Cells for Customized Care

Personalized Cancer Treatment

Dr. Robert Nagourney is founder and director of Nagourney Cancer Institute, a research and testing lab in Long Beach, California that personalizes treatments for cancer patients. Dr. Nagourney is author of the book Outliving Cancer, a TEDx speaker, and a clinical professor at the University of California, Irvine.




Over the past 20+ years, Dr. Nagourney and his team have developed a laboratory technique known as functional profiling which aids in the determination of the best drugs for each patient. Hear Michael A. Smith, MD, interview Robert A. Nagourney, MD, by clicking here to download this Live Foreverish podcast episode for FREE on iTunes!


What is Functional Profiling?

Molecular Profiling for Cancer

“We use each patient’s cancer cells—removed directly from their bodies at the time of surgery—to craft a treatment that is unique to their individual cancer,” Dr. Nagourney explained.

“We believe that cancer is more complicated than its genes, and we have become interested in the prospect of studying cancer biology at the level of the cell,” he elaborated. “So, we perfected a technique to isolate cancer patients’ cells in aggregates that we call organoids. These can reproduce the conditions of a patient’s own tumor, but in a test tube environment. Using these organoids, or microaggregates, we expose the cells to drugs and combinations, targeted agents, immune therapies, metabolomic agents, and we follow the cells to see if we can cause something called programmed cell death, one form of which is apoptosis. When we can see that in the test tube, we have a very good chance of getting the patient better with that drug.”

Tumor Profiling for Targeted Therapy

Go from Generalized to Personalized Cancer Treatment

Rather than administering the standard treatment to all patients with a particular type of cancer, functional profiling embodies a move toward personalized therapy. A cubic centimeter of living cancer cells is all that’s needed. Cells are obtained by the collection of fluid or biopsied tissue and are exposed to various agents. If a significant amount of cell death is observed, it is an indication that the patient could benefit from the agent or combination being tested.1,2 A meta-analysis (which analyzes the results of more than one study) conducted by Dr. Nagourney and colleagues that included data from a total of 1,917 study participants found a two-fold higher response rate and 44% improvement in one-year survival among patients who received treatment guided by functional profiling results, in comparison with patients who received standard care.3


Why don’t we hear more about personalized therapy?

There are two reasons, according to Dr. Nagourney.

“We had two scientific errors. The first was that we thought of cancer as a disease of cell growth and that isn’t the case. It turns out that cancer really succeeds by survival. Cancer is a disease that survives longer—it doesn’t grow faster but survives longer than other cells—and that’s how it builds up into the tumors that we treat. And secondly, cancer isn’t a cell, but a system. There’s a kind of ecology of human cancer. You have to study the cells in aggregates, which is what I mentioned earlier. We studied the actual organ of the cancer, not a cell. So, if you measure cell death instead of growth, and you do it in a microenvironment like the tumor’s own native state, you get a much better answer, and that’s slowly percolating into the literature. There are many people around the country who are reawakening to this, and I think you’ll see a lot more about this in the future.”

“You can change the microenvironment and that changes how that tumor responds, grows or even dies,” Dr. Smith concurred.

What’s in the future for cancer treatment?

Dr. Nagourney reiterated that his group is interested in phenotype as opposed to genotype. Cellular phenotype is the behavior and biology of the cell rather than the structure of its genetic material. When attempting to determine what drives cells to stay alive and how they accomplish this, Dr. Nagourney and his colleagues concluded that the reason can be attributed to metabolism. They recently authored an article concerning the metabolic basis of breast cancer which described how many cancers arise as the result of bioenergetic changes and cellular metabolism.4

“I think that the future will be looking in different directions—looking at cancer cells as metabolic and bioenergetic cells that have to be changed, not at their DNA level, not at their growth rate, but at their metabolism and energy production,” Dr. Nagourney predicted. “If we can do that, we’ll come up with treatments that work better, with less toxicity.”

About Live Foreverish: Join Dr. Mike as he sits down with some of today’s leading medical, health, and wellness experts to discuss a variety of health-related topics. From whole-body health to anti-aging and disease prevention, you’ll get the latest information and helpful advice to help you live your life to the fullest. See the full list of Live Foreverish Podcast episodes, available on demand.

References

1. Nagourney RA. Curr Treat Options Oncol. 2006 Mar;7(2):103-10.
2. Nagourney RA et al. Anticancer Res. 2012 Oct;32(10):4453-60.
3. Apfel C et al. J Clin Oncol. 2013;31suppl;abstr e22188.
4. da Silva I et al. Oncotarget. 2018 Aug 3;9(60):31664-31681.

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