Stories of progress, inspiration, and information in overcoming osteosarcoma.
In its simplest form, precision oncology means diagnosing the type and stage of cancer to treat patients for precisely the cancer that they have, says Katherine Janeway, MD, MMSc, senior physician and director of clinical genomics at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.
Katherine Janeway, MD, MMsc. Photo: Sam Ogden
Within the last decade, precision oncology has made major strides. Scientists can now use genomic information from DNA to refine cancer treatments even further, yielding higher cure rates and fewer side effects. When it comes to using precision medicine to diagnose and treat rare cancers like osteosarcoma, however, there is still a lot of work to be done.
To learn how scientists are bridging gaps in precision oncology for osteosarcoma, The Frontline spoke with Dr. Janeway, who serves as chair of the Osteosarcoma Institute’s Brokers of Osteosarcoma Progress (BOP) Committee.
Precision medicine in cancer treatment involves looking at the genes and reading the DNA errors in a person’s cancer on a personalized level. This is called molecular profiling. Through molecular profiling, we gain understanding about the patient’s diagnosis, and how that specific form of cancer may respond to chemotherapy. We can even identify clinical trials or new treatments that would be closely matched to address that tumor’s DNA errors.
Not all cancer DNA is easy to interpret. Particularly for rare cancers like osteosarcoma, we may be able to identify the tumor profile, but we do not know enough about the cancer yet to interpret the information we gather or predict a person’s response to treatments.
In addition, for many of the abnormalities we find, we either have no drug to treat it, or we have a potential drug that has not yet been proven in clinical trials. Or, we have a drug that is a match, but it is not very effective at turning off the activated abnormality.
I am confident that, with time, we will accumulate more information about tumor profiles and make more technological advances to solve the challenge of interpreting the tumor’s molecular profile.
Finding the right drugs is a bit more complex. We do not just need to find the right drugs and drug combinations, but we need to test them in clinical trials. This requires adequate funding. We are starting to make progress in those areas — with the help of institutions like the Osteosarcoma Institute.
This Phase II trial is evaluating the combination of two drugs that inhibit DNA repair pathways critical to the survival of osteosarcoma cells: olaparib and ceralasertib. It is the first clinical trial to test this combination in osteosarcoma patients. For the most part, pharmaceutical companies are not willing to be the primary funder for an osteosarcoma clinical trial, which has a small market, so clinical trials like these depend on funding from organizations like the OSI.
Over the next 10 years, I think we will have enough clinical data and tumor profiling data to have much greater insight into most childhood cancers — including osteosarcoma. That is very exciting.
The issue with osteosarcoma is that there has not been enough of an invested effort to cure the disease. There have not been enough investigators working in this disease, and there has not been enough funding. Thankfully, that is starting to change.
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