Q: I've been diagnosed with early-stage melanoma. I want the best care possible. I've heard about individualized cancer diagnosis and treatment, but I am not sure what it means. Can you explain?
Sally H., Charlotte, N.C.
A: Absolutely. Because labs can now determine your tumor's DNA mutations and characteristics, doctors can identify the subtype of cancer you have and gauge which treatments and medications will combat it most effectively. At the Cleveland Clinic, Dr. Mike's home base, as well as at other leading cancer-care and research centers, melanoma, breast cancer, colorectal and non-small-cell lung cancer tumor cells can be analyzed and the best treatment options then selected.
In the case of melanoma, DNA analysis of tumors lets new treatments be used early on, before the cancer spreads. Identification of patients with the BRAF gene — about half of melanoma cases are associated with it — makes certain therapies the best choice. And for the 50 percent of folks without that mutation, there's a new agent (ipilimumab, or ipi) that causes remission in up to 15 percent of patients.
There also have been advances in analysis of your own DNA, so you can find out if you have a certain genetic mutation. Discovery may lead you to make the most effective treatment choices or to reduce your risk for cancer, the recurrence of a cancer or development of a second cancer. For example, we know a faulty CDKN2A and CDK4 gene indicates that you're at greater risk for melanoma. And the BRCA-1 or BRCA-2 mutation signals an increased risk for breast, ovarian, prostate or pancreatic cancer.
And treatments are improving: Watson, the Jeopardy-winning IBM supercomputer, is being used to evaluate the overwhelming volume of cancer research so doctors can develop the most up-to-date, individualized treatments possible.
You should go to a cancer center that's recognized for excellence and ask about having your tumor's genes (and yours) analyzed to discover the exact nature of your condition. Then talk to them about treatment options. By the way, new data indicate that increasing your HDL cholesterol level may decrease melanoma spread and increase survival. Good luck!
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