10 years after the Cancer Genome Atlas project published its findings, some its key findings remain in the closet. That is very little has reached the bedside of our patients. Most of the use has benefited research companies that used the information to design drugs most of which remains in clinical trials. Information that could have benefited the day to day practice of oncology, remains away from the reach of practicing physicians because not fully endorsed by leaders in the field. For something to be used, approval by the FDA or strong recommendations by leading bodies such as NCCN and the like must occur for Insurance companies to follow, and for practioners to be able to orders pertinent test to use the knowledge.
ie. "Mutation of FOXA1 could be a marker of endocrine sensitivity...Depletion of FOXA1 abolishes Estrogen Receptor binding capacity..." (Cynthia X et al) That FOXA1 level could predict response to endocrine therapy....This is a major finding. The lack of endorsement makes this finding insufficiently unused in our community of Oncologist. In reality this finding should be reported next to the ER positivity to further affirm that success of therapy is more likely, a fact that will further reassure our patients. In endorsing this fact, technology to make this test will be developed for an easy and more readily use in oncology practice. To spice things up? well Cyclic AMP should also be reported and monitor over time to predict MTOR activity and resistance build up. MTOR inhibitor have shown disease free progression advantage when added to AI. May be we should see resistance coming don't you think? If not C-AMP, may be CRE...now don't start the polemic...! HUMAN.... blocking progress....
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