WIN 2011, 6-8 July, 2011, Paris
WIN 2011: Personalised medicine and a global biomarker database
Dr Richard Schilsky – University of Chicago, USA
Since the beginning of WIN, I was asked to take on responsibilities as Chairman of the scientific advisory board and that also makes me a member of the Directorate of WIN, so I’ve been involved in helping to develop the WIN consortium from its very beginnings to where it is now, which is still close to the beginning but we’re making good progress. We have a terrific scientific advisory board and we have, up until now, already reviewed scientific proposals submitted by the WIN member institutions: five proposals for doing some very innovative and biomarker driven research studies. On Friday morning this week, the General Assembly will consider the recommendations surrounding whether those proposals should be supported by WIN or not, but I can foresee certainly that some will go forward fairly immediately and others will require some further development but eventually will go forward.
What’s emerging from the WIN Symposium 2011 so far?
They range from doing things like developing a global registry of information about biomarkers that are in clinical development or in actual use, and what their potential utilities might be and where they might add value in drug development or where they might fail to add value in drug development. One of the problems that we talk about a lot at this meeting, and that our profession deals with quite a bit, is that we’re very interested in using biomarkers to match the right treatment to the right patient. For some treatments and some tumours and some patients we have very good biomarkers, although the majority of biomarkers that are currently in clinical use are far better at predicting when a treatment will not work than they are in predicting when a treatment will work. So what we really need, as clinical oncologists, are much better positive predictive biomarkers so that we can do a test and have that test guide us towards selecting a treatment that is most likely to work for an individual patient.
A lot of biomarkers have been tried and many have failed and the problem is that particularly the ones that don’t work don’t often make it into the literature. So a lot of scientists keep trying to search for biomarkers, not always being aware of where others have gone before them unsuccessfully, so one of the WIN biomarker projects is actually to create a global database of biomarkers that have been tried, have been successful, have failed and inform the scientific community much more broadly and much more easily about the status of biomarker development around the world.
The other projects are related on either developing prognostic biomarkers, so tests that might be based out of serum, looking at circulating biomarkers, to either predict what a patient’s clinical course is going to be, or what is the probability that they’re going to relapse after a course of treatment. And then there are several projects that are focussing more on the development of predictive biomarkers, that is markers that can be used to select specific treatments for specific types of tumours. So these are all very difficult studies to do and I think those are some of the themes we’re already hearing emerging in the meeting: the difficulty surrounding obtaining adequate tissue specimens on patients; the need potentially to obtain tissue on more than one occasion; the quantity of tissue that’s available; the quality of the tissue that’s available; handling it in such a way that results are reliable and reproducible. Then we get into issues surrounding what technologies are the best ones used to interrogate the specimens and can we be using single assays or do we need multiplex assays, and if so, are we looking for mutations, are we looking for copy number variation, are we looking for expression profiles and what’s going to be the most informative? And a variety of those types of pieces of information or themes keep emerging at this meeting.
I think it’s becoming very clear that what we now consider to be the state of the art of personalised cancer treatment is still very far from where we need to be, so we’ve moved from an era when we understood virtually nothing about the cancer and just gave the same treatment to everyone to now a situation where we can do a basic interrogation of most kinds of cancer, typically looking for single genetic mutations that may guide us towards a specific course of treatment. But oftentimes many of the benefits that the patient develops from receiving targeted therapies are very short-lived because resistance mechanisms develop and it’s increasingly clear that we need to use combinations of therapies in order to get the maximum benefit for our patients. Exactly how to combine drugs, which drugs to combine, how many, in what sequence, at what doses and with an adequate safety profile, I think are enormously complicated issues that were discussed in that session that I chaired this morning at the meeting.
Where does the funding come from for a worldwide biomarker database?
So far it’s come mostly from the member institutions that have actually joined WIN, and there are now 25 or so institutions from almost every continent in the world that have joined WIN and paid membership dues. It’s likely that a lot of the basic operating infrastructure of WIN will come from the membership dues. The funding for the specific research projects will have to come from the traditional funding sources: government grants, private foundations, partnerships with the pharmaceutical industry and so on.
What is the future for the WIN Consortium?
We’re very encouraged; we think what is very unique about WIN is the global nature of it. It is remarkable to me that outstanding cancer centres from all around the world have been willing to buy into the concept because, so far, there’s not that much reality to WIN but there’s a wonderful concept. At this meeting a lot of the reality is beginning to take shape, we’ve been having workshops on biobanking, workshops on criteria for membership, workshops on auditing, compliance, quality control – the kinds of things that we need to develop an infrastructure to actually operationalize WIN as a global network that can do biomarker driven studies.