One of the most promising treatments for early stage and advanced lung cancer now is available in Beaufort County.
In collaboration with local affiliate Beaufort Memorial Hospital, Duke University physicians and scientists have begun enrolling area residents in genomic clinical trials, studies that offer lung cancer patients the opportunity to receive personalized treatment based on the individual genetic signature of their tumors.
Using the unique molecular traits of a patient's cancer cells, oncologists might be able to better predict which chemotherapy treatment is likely to be successful, improving outcomes and sparing patients from side effects associated with cancer-fighting drugs that will not benefit them.
"There are a certain number of people who wouldn't respond to the best chemotherapy regimen available," said oncologist Dr. Majd Chahin, principal investigator for Beaufort Memorial Hospital's clinical trials program. "If we know this in advance, we can improve their chances with chemotherapy that is more effective. The first chemo treatments are the ones that make the most difference."
Under today's best standards of care, oncologists choose the type of chemotherapy to give their patients based on the general features of their tumors. Then they have to wait and see how the cancer responds. By the time they determine the chemo has not been effective, the disease has progressed and the patient has been weakened from the toxicity of the chemicals.
"Right now, we don't have a good way to choose the best treatment for individual patients," said Dr. Neal Ready of Duke's Comprehensive Cancer Center. "Too many people are getting the side effects of chemotherapy without getting the maximum benefits."
The studies are open to patients with non-squamous non-small cell lung cancer in stages 1b, 2 or 3a and non-small cell lung cancer in stages 3b or 4. In both the early stage and advanced lung cancer trials, researchers will be testing two FDA-approved chemotherapy regimens that have been shown to be most effective on those particular types of cancer.
With early stage lung cancer, the tumor typically is removed before chemotherapy is started. Patients participating in the study will go to Duke for the surgery since it is not available at Beaufort Memorial Hospital. Tissue taken from the tumor will be used for the genomic testing.
Because surgery is not an option for advanced lung cancer patients, a biopsy of the tumor will be taken at Beaufort Memorial Hospital and shipped to Duke for the testing.
Using a special tool called a gene chip, Duke scientists will analyze the sample tissue, recording information on about 30,000 genes. The genomic profile will be fed into models that predict the response the tumor will have to the two different chemotherapies.
"We're talking about a significantly more precise treatment for our patients," Chahin said. "It's a big leap from current practices."
Once the tests determine which chemicals have the greatest chance of success, Beaufort Memorial oncologists will begin the chemotherapy treatments at the hospital's Keyserling Cancer Center.
As a Duke Medicine affiliate, Beaufort Memorial is one of only five hospitals in the country that have been invited to participate in the study. Most of the hospitals conducting the genomic clinical trials are only offering the early stage cancer test.