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Dow Jones Reprints: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues, clients or customers, use the Order Reprints tool at the bottom of any article or visit www.djreprints.com ||||| Two large research teams have produced exhaustive genomic studies that reveal the most detailed catalog yet of the mutations that drive two deadly cancers—endometrial cancer and acute myeloid leukemia. The two studies of samples taken from hundreds of patients suggest new possible drug targets and ways to divide cancers into subtypes that might respond differently to treatment. 
  
 The new data are the latest fruits of a major national effort to create an atlas of the DNA blueprints of at least 20 types of cancer. Genomic data have been churned out in the past few years for five other cancers, and more are expected over the next year. 
  
 While the results are being hailed as major technological and scientific feats that provide powerful insights into diseases in dire need of progress, they are just first steps toward the goals most patients and physicians care about: lengthening lives or curing cancer. 
  
 Dana-Farber Cancer Institute adult leukemia specialist Dr. David Steensma welcomed the new data, but also provided a bit of a reality check on how far the knowledge is from changing patient care, in an essay published in the New England Journal of Medicine called “The Beginning of the End of the Beginning in Cancer Genomics.” 
  
 Steensma argues that data-rich genome studies of cancer are a crucial step, providing information that will guide drug developers and the design of clinical trials. But he notes that as the era of generating these large reference datasets is coming to a close, a new phase of research will open up. The genome is a powerful starting position in the effort to transform patient care and treat cancers more effectively, not the end. 
  
 Mapping the genomic architecture of most major cancers is “already being done or almost done,” Steensma said. “That sort of huge survey, that sort of large landscape of what’s actually mutated in these tumors is going to be done within a year or two for all the common tumors, all the really big killers. ... So we’re getting to the end of that first era.” 
  
 Steensma draws an analogy to 1803, when explorers Meriwether Lewis and William Clark began preparing to map the west. The cancer genome atlas, Steensma argues, is like that first exploration of unknown territory. But that initial survey was just the beginning. Today, when property is sold, land surveyors still go out and denote boundaries; what were once the tools of discovery are now used in everyday transactions. Steensma foresees the same thing happening as knowing the genomic landscape of the tumors is integrated into the clinic. 
  
 Steensma views the new data as a boon that might help alter a depressing state of affairs in his field, in which treatment of acute myeloid leukemia hasn’t changed from a chemotherapy regimen that was developed when he was a kid playing Little League in the 1970s. 
  
 “There have been more than 30 trials trying to improve on that, and nothing has been shown to be better,” Steensma said. 
  
 Steensma says the new data point to new therapeutic strategies that could be tried and novelways to partition patients into groups. For example, a Cambridge biotechnology company, Agios Pharmaceuticals, has drugs in development that target a mutated gene found in a fraction of cases of AML. 
  
 The study of endometrial cancer, published in the journal Nature, similarly opens up new research avenues, said Raju Kucherlapati, a professor of genetics at Harvard Medical School and Brigham and Women’s Hospital and a co-author of the study. 
  
 Endometrial tumors are often classified based on the types of cells in the tumor and traditional pathological examination of the tissue. What the new study suggests, Kucherlapati said, is that genetic analysis could provide a more effective way of classifying the disease into subtypes, using criteria such as the number of extra copies of stretches of DNA. 
  
 “If you classify them [the tumors] based on these new criteria, you might be able to have better therapeutic approaches,” Kucherlapati said. For example, the new data indicate that a certain subset of patients might benefit from chemotherapy, rather than radiation. 
  
 That’s a hypothesis that will have to be tested in patients to see whether it turns out to be true. The paper also hints at the broader use of the cancer genome atlas, as a tool to navigate cancer. But identifying which features are important landmarks that could help guide treatment will require new studies, informed by the DNA databases now being compiled. ||||| “This is exploring the landscape of cancer genomics,” said Dr. David P. Steensma, a leukemia researcher at the Dana-Farber Cancer Institute who was not involved with the studies. “Many developments in medicine are about treatments or tests that are only useful for a certain period of time until something better comes by. But this is something that will be useful 200 years from now. This is a landmark that will stand the test of time.” 
  
 Advertisement Continue reading the main story 
  
 Dr. Douglas Levine of Memorial Sloan Kettering Cancer Center, the principal investigator on the endometrial cancer study, said the group scoured the country for samples of this cancer. 
  
 The cancer has long been evaluated by pathologists who examine thin slices of endometrial tumors under a microscope and put them in one of two broad categories. But the method is not ideal. In general, one category predicts a good prognosis and tumors that could be treated with surgery and radiation, while the other holds a poorer prognosis and requires chemotherapy after surgery. But pathologists often disagree about how to classify the tumors and can find it difficult to distinguish between the two types, Dr. Levine said. 
  
 The new genetic analysis of hundreds of tumors found patterns of genetic aberrations that more precisely classify the tumors, dividing them into four distinct groups. About 10 percent of tumors that had seemed easily treated with the old type of exam now appear to be more deadly according to the genetic analysis and would require chemotherapy. 
  
 Advertisement Continue reading the main story 
  
 Another finding was that many endometrial cancers had a mutation in a gene that had been seen before only in colon cancers. The mutation disables a system for repairing DNA damage, resulting in 100 times more mutations than typically occur in cancer cells. 
  
 Photo 
  
 “That was a complete surprise,” Dr. Levine said. 
  
 It turned out to be good news. Endometrial cancers with the mutation had better outcomes, perhaps because the accumulating DNA damage is devastating to cancer cells. 
  
 Advertisement Continue reading the main story 
  
 Another surprise was that the worst endometrial tumors were so similar to the most lethal ovarian and breast cancers, raising the tantalizing possibility that the three deadly cancers might respond to the same drugs. 
  
 Please verify you're not a robot by clicking the box. Invalid email address. Please re-enter. You must select a newsletter to subscribe to. Sign Up Receive occasional updates and special offers for The New York Times's products and services. Thank you for subscribing. An error has occurred. Please try again later. View all New York Times newsletters. 
  
 Jeff Boyd, executive director of the Cancer Genome Institute at Fox Chase Cancer Center, who was not involved with the new research, said the similarity among breast, ovarian and endometrial tumors was the best example yet of the idea that cancers are more usefully classified by their gene mutations than by where they originate. Though many scientists believe this view is correct, Dr. Boyd said, “It is very rewarding — I can’t overstate it” to see it validated with real data. 
  
 While the genetics of endometrial cancer had gone largely unstudied until now, acute myeloid leukemia has been investigated for decades, in part because leukemia cells are so accessible. They are in the blood and bone marrow. 
  
 Using microscopes and special staining methods, researchers had already discovered, for example, that chromosomes in these leukemia cells are often broken or hooked together in strange ways. They also knew that some chromosomal alterations were associated with a good prognosis, and others with a bad one. Patients with a good prognosis can usually be treated with chemotherapy alone while those with a worse prognosis need the expensive, difficult and risky treatment of last resort: a bone marrow transplant. It comes with a 10 percent death rate. 
  
 Advertisement Continue reading the main story 
  
 The problem was that the traditional methods for categorizing the leukemia were imprecise, said Dr. Timothy Ley of Washington University in St. Louis, who led the study with Richard Wilson, also of Washington University. Nearly half the acute myeloid leukemias had normal chromosomes. There was no good way to decide which treatment these patients needed. Some did well with chemotherapy; some did poorly. 
  
 Advertisement Continue reading the main story 
  
 “It was a huge conundrum,” Dr. Ley said. “For patients who cannot be cured with chemotherapy, we have a potentially curative therapy. But picking the right patients for a transplant was very difficult.” 
  
 The new study of 200 acute myeloid leukemias identified at least 260 genes that were mutated in at least 2 of the 200 leukemia samples, finding virtually all of the common genetic malfunctions that occur in it. Now researchers have a new foundation for assessing which cancers will be lethal unless the patient gets a risky bone marrow transplant and which can be treated with chemotherapy alone. 
  
 “We have the basic playbook,” Dr. Ley said. “We finally know what the major pathways are and what all the major mutations look like.” And knowing which genes are mutated also allows researchers to investigate drugs that target those genes. 
  
 Advertisement Continue reading the main story 
  
 The next step will be for investigators to determine which mutations lead to good or bad outcomes. 
  
 “Within two or three years, risk assessment may be dramatically better,” Dr. Ley said. “It certainly sets the stage for the next era of therapy.” |||||
– Two major studies of common cancers have zeroed in on the particular gene mutations associated with both, a breakthrough that could lead to better treatment for those with acute myeloid leukemia and endometrial cancer, reports the Boston Globe. But the studies also lend credence to a broader idea: that our traditional way of defining cancer by the organ in which it originates is outdated, reports the New York Times. Instead, it might be time to start thinking of cancer in terms of genetic mutations. In the latest studies, for example, researchers were surprised to discover that the worst endometrial tumors of the uterine were remarkably similar to the worst forms of breast and ovarian cancer. That raises "the tantalizing possibility that the three deadly cancers might respond to the same drugs," writes the Times' Gina Kolata. This emerging approach is called "precision medicine," notes the Wall Street Journal. The theory has been around for a while, but the new research under the sprawling Cancer Genome Atlas project seems to validate it. "It is very rewarding—I can't overstate it," says one expert not affiliated with the work.
Skriv en sammanfattning baserad på denna artikel: Dow Jones Reprints: Denna kopia är endast för personligt, icke-kommersiellt bruk. För att beställa presentationsklara kopior för distribution till dina kollegor, kunder eller kunder, använd Order Reprints verktyg längst ner i någon artikel eller besök www.djreprints.com <unk> Två stora forskargrupper har producerat uttömmande genomiska studier som avslöjar den mest detaljerade katalogen hittills av mutationer som driver två dödliga cancer-endometriecancer och akut myeloisk leukemi. De två studierna av prover tagna från hundratals patienter tyder på nya möjliga läkemedelsmål och sätt att dela in cancer i subtyper som kan reagera olika på behandling. De nya uppgifterna är de senaste frukterna av en stor nationell insats för att skapa en atlas av DNA-ritningarna för minst 20 typer av cancer. Genomiska data har under de senaste åren utstötts för fem andra cancerformer, och fler förväntas under det kommande året. Även om resultaten hyllas som stora teknologiska och vetenskapliga bedrifter som ger kraftfulla insikter i sjukdomar i trängande behov av framsteg, är de bara första steg mot de mål som de flesta patienter och läkare bryr sig om: att förlänga liv eller bota cancer. Dana-Farber Cancer Institute vuxen leukemi specialist Dr David Steensma välkomnade de nya data, men också gett lite av en reality check på hur långt kunskapen är från att förändra patientvård, i en essä publicerad i New England Journal of Medicine kallad “The Beginning of the End of the Beginning in Cancer Genomics.” Steensma hävdar att datarika genomstudier av cancer är ett avgörande steg, ger information som kommer att vägleda läkemedelsutvecklare och utformningen av kliniska prövningar. Men han konstaterar att när eran av att generera dessa stora referensdataset närmar sig sitt slut, kommer en ny fas av forskning att öppnas upp. Genomet är en kraftfull utgångspunkt i arbetet med att omvandla patientvården och behandla cancer mer effektivt, inte slutet. Kartläggning av den genomiska arkitekturen för de flesta stora cancerformer är “redan görs eller nästan görs,” Steensma sade. “Den typen av enorm undersökning, den typen av stora landskap av vad som faktiskt muteras i dessa tumörer kommer att göras inom ett år eller två för alla vanliga tumörer, alla de riktigt stora mördarna. ... Så vi kommer till slutet av den första eran. " Steensma drar en analogi till 1803, när upptäckarna Meriwether Lewis och William Clark började förbereda sig för att kartlägga den västra. Cancergenomet atlas, hävdar Steensma, är som den första utforskningen av okänt territorium. Men den inledande undersökningen var bara början. Idag, när egendom säljs, går landtmätare fortfarande ut och betecknar gränser; vad som en gång var upptäcktens verktyg används nu i vardagliga transaktioner. Steensma förutser samma sak som att veta det genomiska landskapet av tumörerna är integrerad i kliniken. Steensma ser de nya data som en välsignelse som kan bidra till att förändra ett deprimerande tillstånd i sitt område, där behandling av akut myeloisk leukemi inte har förändrats från en kemoterapi regim som utvecklades när han var ett barn som spelar Little League på 1970-talet. “Det har varit mer än 30 prövningar försöker förbättra på det, och ingenting har visat sig vara bättre,” Steensma sade. Steensma säger att de nya data pekar på nya terapeutiska strategier som kan provas och nya sätt att dela upp patienter i grupper. Ett bioteknikföretag i Cambridge, Agios Pharmaceuticals, har till exempel läkemedel i utveckling som riktar sig mot en muterad gen som finns i en bråkdel av fallen av AML. Studien av endometriecancer, som publiceras i tidskriften Nature, öppnar på liknande sätt nya forskningsvägar, säger Raju Kucherlapati, professor i genetik vid Harvard Medical School och Brigham and Women’s Hospital och medförfattare till studien. Endometrietumörer klassificeras ofta utifrån celltyperna i tumören och traditionell patologisk undersökning av vävnaden. Vad den nya studien föreslår, sade Kucherlapati, är att genetisk analys skulle kunna ge ett effektivare sätt att klassificera sjukdomen i subtyper, med hjälp av kriterier som antalet extra kopior av DNA-sträckor. “Om du klassificerar dem [tumörerna] baserat på dessa nya kriterier, kanske du kan ha bättre terapeutiska metoder,” Kucherlapati sade. De nya uppgifterna tyder till exempel på att en viss undergrupp av patienter kan dra nytta av kemoterapi, snarare än strålning. Det är en hypotes som måste testas hos patienter för att se om det visar sig vara sant. Tidningen ger också en antydan om att cancergenomets atlas används i större utsträckning, som ett verktyg för att navigera i cancer. Men att identifiera vilka funktioner som är viktiga landmärken som skulle kunna hjälpa till att vägleda behandlingen kräver nya studier, informerade av de DNA-databaser som nu är under sammanställning. ”Detta är att utforska landskapet av cancergenomik”, sade dr David P. Steensma, en leukemiforskare vid Dana-Farber Cancer Institute som inte var involverad i studierna. – Många utvecklingar inom medicinen handlar om behandlingar eller tester som bara är användbara under en viss tid tills något bättre kommer genom. Men detta är något som kommer att vara användbart om 200 år. Detta är ett landmärke som kommer att stå provet av tiden.” Advertisement Fortsätt läsa huvudberättelsen Dr Douglas Levine från Memorial Sloan Kettering Cancer Center, huvudutredaren på endometriecancer studien, sade gruppen sökte landet för prover av denna cancer. Cancern har länge utvärderats av patologer som undersöker tunna skivor av endometrietumörer under ett mikroskop och placerar dem i en av två breda kategorier. Men metoden är inte idealisk. I allmänhet förutspår den ena kategorin en bra prognos och tumörer som skulle kunna behandlas med kirurgi och strålning, medan den andra håller en sämre prognos och kräver kemoterapi efter operation. Men patologer är ofta oense om hur tumörerna ska klassificeras och kan ha svårt att skilja mellan de två typerna, sade doktor Levine. Den nya genetiska analysen av hundratals tumörer fann mönster av genetiska avvikelser som mer exakt klassificerar tumörerna, dela upp dem i fyra skilda grupper. Omkring 10 procent av tumörerna som verkade lätt behandlade med den gamla typen av examen verkar nu vara dödligare enligt den genetiska analysen och skulle kräva kemoterapi. Annons Fortsätt läsa huvudberättelsen Ett annat fynd var att många endometriecancer hade en mutation i en gen som tidigare endast hade setts i tjocktarmscancer. Mutationen inaktiverar ett system för att reparera DNA-skador, vilket resulterar i 100 gånger fler mutationer än normalt förekommer i cancerceller. Foto “Det var en fullständig överraskning,” Dr Levine sade. Det var goda nyheter. Endometriecancer med mutationen hade bättre utfall, kanske för att den ackumulerande DNA-skadan är förödande för cancerceller. Annons Fortsätt läsa huvudberättelsen En annan överraskning var att de värsta endometrietumörer var så lika de mest dödliga äggstocks- och bröstcancer, vilket ökar den lockande möjligheten att de tre dödliga cancerfallen kan svara på samma läkemedel. Kontrollera att du inte är en robot genom att klicka på rutan. Ogiltig e- postadress. Var snäll och gå in igen. Välj ett nyhetsbrev att prenumerera på. Registrera dig Få enstaka uppdateringar och specialerbjudanden för The New York Times produkter och tjänster. Tack för att du prenumererade. Ett fel har uppstått. Försök igen senare. Visa alla New York Times nyhetsbrev. Jeff Boyd, verkställande direktör för Cancer Genome Institute vid Fox Chase Cancer Center, som inte var inblandad i den nya forskningen, sade likheten mellan bröst, äggstockar och endometrietumörer var det bästa exemplet hittills på idén att cancer är mer användbart klassificeras av deras genmutationer än av var de härstammar. Även om många forskare tror att denna uppfattning är korrekt, Dr Boyd sade, "Det är mycket givande - Jag kan inte överstate det" att se det valideras med verkliga data. Medan genetiken av endometriecancer hade gått till stor del ostuderat fram till nu, akut myeloisk leukemi har undersökts i årtionden, delvis eftersom leukemiceller är så tillgängliga. De finns i blodet och benmärgen. Med hjälp av mikroskop och speciella färgningsmetoder hade forskare redan upptäckt till exempel att kromosomer i dessa leukemiceller ofta bryts eller hakas ihop på egendomliga sätt. De visste också att vissa kromosomförändringar var förknippade med en bra prognos, och andra med en dålig. Patienter med god prognos kan oftast behandlas med enbart kemoterapi medan de med sämre prognos behöver den dyra, svåra och riskfyllda behandlingen av sista utvägen: en benmärgstransplantation. Det kommer med en 10 procents dödstal. Annons Fortsätt läsa huvudberättelsen Problemet var att de traditionella metoderna för att kategorisera leukemin var oprecisa, sade dr Timothy Ley vid Washington University i St Louis, som ledde studien med Richard Wilson, också vid Washington University. Nästan hälften av de akuta myeloiska leukemierna hade normala kromosomer. Det fanns inget bra sätt att avgöra vilken behandling dessa patienter behövde. Somliga gjorde bra ifrån sig med kemoterapin; somliga gjorde dåligt ifrån sig. Annons Fortsätt läsa huvudberättelsen “Det var en enorm gåta,” Dr Ley sade. – För patienter som inte kan botas med kemoterapi har vi en potentiellt botande behandling. Men att välja rätt patienter för en transplantation var mycket svårt.” Den nya studien av 200 akuta myeloiska leukemier identifierade minst 260 gener som muterades i minst 2 av de 200 leukemiproven, och fann praktiskt taget alla de gemensamma genetiska fel som förekommer i den. Nu har forskarna en ny grund för att bedöma vilka cancerformer som kommer att vara dödliga om inte patienten får en riskfylld benmärgstransplantation och som kan behandlas med enbart kemoterapi. — Vi ha den grundläggande lekboken, sade doktor Ley. – Vi vet äntligen vilka de viktigaste vägarna är och hur alla de stora mutationerna ser ut. Och att veta vilka gener som muteras gör det också möjligt för forskare att undersöka läkemedel som riktar sig mot dessa gener. Annons Fortsätt läsa huvudberättelsen Nästa steg blir för utredare att avgöra vilka mutationer som leder till bra eller dåliga utfall. “Inom två eller tre år, riskbedömning kan vara dramatiskt bättre,” Dr Ley sade. “Det sätter verkligen scenen för nästa era av terapi.”
Write a summary based on this article: Dow Jones Reprints: This copy is for personal, non-commercial use only. To order ready-to-present copies for distribution to your colleagues, customers or customers, use Order Reprint's tools at the bottom of any article or visit www.djreprints.com <unk> Two major research groups have produced exhaustive genomic studies that reveal the most detailed catalog to date of mutations that drive two deadly cancer-endometrial cancers and acute myeloid leukaemia. The two studies of samples taken from hundreds of patients suggest new possible drug targets and ways to divide cancer into subtypes that may react differently to treatment. The new data are the latest fruits of a major national effort to create an atlas of DNA drawings for at least 20 types of cancer. Genomic data have been outcasted in recent years for five other cancers, and more are expected in the coming year. Although the results are hailed as major technological and scientific achievements that provide powerful insights into diseases in urgent need of progress, they are only first steps toward the goals that most patients and doctors care about: prolonging life or curing cancer. Dana-Farber Cancer Institute adult leukemia specialist Dr David Steensma welcomed the new data, but also provided little of a reality check on how far the knowledge is from changing patient care, in an essay published in the New England Journal of Medicine called “The Beginning of the End of the Beginning in Cancer Genomics.” Steensma claims that data-rich genome studies of cancer are a crucial step, providing information that will guide drug developers and the design of clinical trials. But he notes that as the era of generating these large reference data sets approaches its end, a new phase of research will open up. The genome is a powerful starting point for transforming patient care and treating cancer more effectively, not the end. Mapping the genomic architecture of most major cancers is “already made or almost done,” Steensma said. “That kind of huge examination, that kind of great landscape of what is actually mutated in these tumors will be done within a year or two for all the common tumors, all the really big killers. ... So we come to the end of the first era." Steensma draws an analogy to 1803, when discoverers Meriwether Lewis and William Clark began preparing to map the west. The cancer genome atlas, Steensma claims, is like the first exploration of unknown territory. But the initial investigation was only the beginning. Today, when property is sold, land gauges still go out and signify boundaries; what was once the tool of discovery is now used in everyday transactions. Steensma anticipates the same thing as knowing the genomic landscape of the tumors is integrated into the clinic. Steensma sees the new data as a blessing that can help change a depressing state in his area, where treatment of acute myeloid leukaemia has not changed from a chemotherapy regimen that developed when he was a child playing Little League in the 1970s. “There have been more than 30 trials trying to improve on it, and nothing has proven to be better,” Steensma said. Steensma says that the new data point to new therapeutic strategies that can be tested and new ways to divide patients into groups. For example, a biotech company in Cambridge, Agios Pharmaceuticals, has developmental drugs targeting a mutated gene found in a fraction of cases of AML. The study of endometrial cancer, published in Nature magazine, similarly opens new research paths, says Raju Kucherlapati, professor of genetics at Harvard Medical School and Brigham and Women’s Hospital and co-author of the study. Endometrial tumours are often classified based on the cell types in the tumor and traditional pathological examination of the tissue. What the new study suggests, Kucherlapati said, is that genetic analysis could provide a more effective way to classify the disease into subtypes, using criteria such as the number of extra copies of DNA stretches. “If you classify them [the tumors] based on these new criteria, you might have better therapeutic methods,” Kucherlapati said. For example, the new data suggest that a certain subset of patients can benefit from chemotherapy, rather than radiation. It is a hypothesis that must be tested in patients to see if it turns out to be true. The paper also gives an indication that the cancer genome's atlas is being used to a greater extent, as a tool for navigating cancer. However, identifying which features are important landmarks that could help guide the treatment requires new studies, informed by the DNA databases that are now under compilation. “This is exploring the landscape of cancer genomics,” said Dr. David P. Steensma, a leukemia researcher at the Dana-Farber Cancer Institute who was not involved in the studies. “Many developments in medicine are about treatments or tests that are only useful for a certain period of time until something better comes through. But this is something that will be useful in 200 years' time. This is a landmark that will stand the test of time.” Advertisement Continue reading the main story Dr. Douglas Levine of Memorial Sloan Kettering Cancer Center, the main investigator of the endometrial cancer study, said the group sought the country for samples of this cancer. The cancer has long been evaluated by pathologists who examine thin slices of endometrial tumours under a microscope and place them in one of two broad categories. But the method is not ideal. In general, one category predicts a good prognosis and tumors that could be treated with surgery and radiation, while the other holds a worse prognosis and requires chemotherapy after surgery. But pathologists often disagree on how the tumors should be classified and may find it difficult to distinguish between the two types, Dr. Levine said. The new genetic analysis of hundreds of tumors found patterns of genetic abnormalities that more accurately classify the tumors, dividing them into four distinct groups. About 10 percent of the tumors that appeared to be easily treated with the old type of exam now appear to be more lethal according to the genetic analysis and would require chemotherapy. Advertisement Continue reading the main story Another finding was that many endometrial cancers had a mutation in a gene that had previously only been seen in colon cancer. The mutation inactivates a system to repair DNA damage, resulting in 100 times more mutations than normal occurring in cancer cells. Photo “It was a complete surprise,” Dr. Levine said. That's good news. Endometrial cancer with the mutation had better outcomes, perhaps because the accumulating DNA damage is devastating to cancer cells. Advertisement Continue reading the main story Another surprise was that the worst endometrial tumours were so similar to the most deadly ovarian and breast cancers, increasing the alluring possibility that the three fatal cancers can respond to the same drug. Check that you are not a robot by clicking on the box. Invalid email address. Please go back inside. Select a newsletter to subscribe to. Sign up Get occasional updates and special offers for The New York Times products and services. Thank you for subscribing. There's been an error. Try again later. Show all New York Times newsletters. Jeff Boyd, executive director of the Cancer Genome Institute at the Fox Chase Cancer Center, who was not involved in the new research, said the similarity between breasts, ovaries and endometrial tumours was the best example to date of the idea that cancer is more usefully classified by their gene mutations than by where they originate. Although many scientists believe this view is correct, Dr. Boyd said, "It's very rewarding - I can't overstate it" to see it validated with real data. While the genetics of endometrial cancer had been largely unsuded until now, acute myeloid leukaemia has been investigated for decades, partly because leukemia cells are so available. They're in the blood and bone marrow. By means of microscopes and special dyeing methods, researchers had already discovered, for example, that chromosomes in these leukemia cells are often broken or hooked together in strange ways. They also knew that some chromosome changes were associated with a good prognosis, and others with a bad one. Patients with good prognosis can usually be treated with chemotherapy alone while those with worse prognosis need the expensive, severe and risky treatment of last resort: a bone marrow transplant. It comes with a 10% death rate. Advertisement Continue reading the main story The problem was that the traditional methods of categorizing leukemia were imprecise, said Dr Timothy Ley of Washington University in St. Louis, who led the study with Richard Wilson, also at Washington University. Almost half of the acute myeloid leukaemias had normal chromosomes. There was no good way to determine what treatment these patients needed. Some did well with chemotherapy; some did badly. Advertisement Continue reading the main story “It was a huge riddle,” Dr. Ley said. “For patients who cannot be cured with chemotherapy, we have a potentially curative treatment. But choosing the right patients for a transplant was very difficult.” The new study of 200 acute myeloid leukaemias identified at least 260 genes mutated in at least 2 of the 200 leukemia samples, and found virtually all the common genetic errors that occur in it. Now the researchers have a new basis for assessing which cancers will be fatal unless the patient receives a risky bone marrow transplant and can be treated with chemotherapy alone. “We have the basic playbook,” said Dr. Ley. “We finally know what the most important routes are and what all the major mutations look like. And knowing which genes are mutated also enables researchers to investigate drugs targeting these genes. Advertisement Continue reading the main story The next step will be for investigators to determine which mutations lead to good or bad outcomes. “Within two or three years, risk assessment can be dramatically better,” Dr. Ley said. “It really sets the stage for the next era of therapy.”
– Två stora studier av vanliga cancerformer har nollat in på de särskilda genmutationer som är förknippade med båda, ett genombrott som kan leda till bättre behandling för dem med akut myeloisk leukemi och endometriecancer, rapporterar Boston Globe. Men undersökningarna ger också trovärdighet åt en bredare idé: att vårt traditionella sätt att definiera cancer med det organ det har sitt ursprung i är föråldrat, rapporterar New York Times. Istället kan det vara dags att börja tänka på cancer i termer av genetiska mutationer. I de senaste studierna blev till exempel forskarna förvånade över att upptäcka att livmoderns värsta endometrietumörer var anmärkningsvärt lika de värsta formerna av bröst- och äggstockscancer. Det väcker "den lockande möjligheten att de tre dödliga cancerfallen kan reagera på samma läkemedel", skriver Times Gina Kolata. Denna framväxande metod kallas "precision medicin", konstaterar Wall Street Journal. Teorin har funnits ett tag, men den nya forskningen under det spretiga projektet Cancer Genome Atlas verkar validera den. "Det är mycket givande – jag kan inte överdriva det", säger en expert som inte är knuten till arbetet.
“Two major studies of common cancers have zeroed into the specific gene mutations associated with both, a breakthrough that can lead to better treatment for those with acute myeloid leukaemia and endometrial cancer,” reports the Boston Globe. But the studies also give credibility to a broader idea: that our traditional way of defining cancer with the body it originated is obsolete, reports the New York Times. Instead, it may be time to start thinking about cancer in terms of genetic mutations. For example, in recent studies, researchers were surprised to discover that the worst endometrial tumours in the uterus were remarkably similar to the worst forms of breast and ovarian cancer. It raises "the enticing possibility that the three fatal cancer cases may react to the same drug," writes Times Gina Kolata. This emerging method is called "precision medicine," notes the Wall Street Journal. The theory has existed for a while, but the new research under the sprawling project Cancer Genome Atlas seems to validate it. "It's very rewarding – I can't exaggerate it," says an expert who is not associated with the work.