Exploring the Next Frontier of Cancer Biomarkers in Precision Medicine

Regarding finding the right drug for the right patient, the reality of cancer management is far more complex than a single genetic mutation, according to David Rimm, MD, PhD.

In a conversation with CancerNetwork^®, Rimm spoke about biomarker research that may hold promise in the management of melanoma, lung cancer, breast cancer, and other disease types. He argued that to truly improve patient outcomes, the field must expand its focus beyond DNA-based diagnostics to a more comprehensive analysis of other biomolecules. Specifically, he highlighted the potential role of protein-based methods, as well as those focused on RNA and circulating DNA, in providing a more nuanced understanding of a tumor’s behavior. These approaches, he described, may help optimize strategies for administering the right treatments to the right patients.

Rimm is the Anthony N. Brady Professor of Pathology and a professor of Medicine (Medical Oncology) at Yale University School of Medicine.

Transcript:

One of the big clinical questions is, "Who should get which drug?" This has been a question for as long as drugs have existed. As we have gotten better at precision medicine, we have [developed] more tools to help us predict responses to drugs....We have had a good run in DNA-based diagnostics, and we are still improving them. But it turns out that drugs are not always working with just 1 mutation. One mutation does not always direct us to which patient should get which drug. That’s where we are now: we need to think beyond DNA into the other biomolecules that are out there that could be taken advantage of for helping select the right drug for the right patient.

My particular interest has always been protein-based methods, but there are methods that relate to circulating DNA, whether it’s bound or free circulating DNA. There are methods that are based on the RNA or expression profiles in RNA. There’s a lot of other methods out there that we will be watching closely in the next 5 to 10 years to change the way we prescribe drugs so that we do not give the same drug to everybody but rather give the best drug to the right patient.