Rutgers Cancer Institute of New Jersey At the Cutting Edge of Precision Medicine Initiative

Robert S DiPaola, MD. Director, CINJ, RWJMS
Robert S DiPaola, MD. Director, CINJ, RWJMS

Precision medicine can personalize treatment options for patients with cancers that are resistant to standard therapies, said Robert DiPaola, director of the Rutgers Cancer Institute of New Jersey.

The CINJ is the only National Cancer Institute Designated Cancer Center in New Jersey, one of 41 centers named by the federal government's National Cancer Institute, he said.

“That's important because, under that designation, there are various activities and functions that we have as an NCI designated center," DiPaola said. "[These include] research activities, both in the laboratory for new discoveries for cancer and prevention, and clinical activities where we treat patients that come in with cancer or high risk for cancer.”

Precision medicine, also called personalized medicine, was launched at CINJ and other NCI designated centers several years ago and seeks to make therapy more precise to attack an individual's particular tumor.

Patients that have tumors resistant to standard therapies are enrolled in trials where their genes are sequenced, DiPaola said. Abnormal genes are found and a team of experts determine what therapies would be most effective against them.

Gene sequencing is a process where a composition of all the DNA inside an organism is taken and the sequence of the DNA nucleotides that make up the genome are determined, said Sabri Rafi, a School of Arts and Sciences junior.

In gene sequencing, the object is to map out the nucleotides that make up the genomic profile of the patient so that you can compare parts of the genome to the standard genetic profile of the cancer, said Hema Arikala, a School of Arts and Sciences senior.

“Genetics plays a significant role in cancer treatment,” Arikala, who is majoring in cell biology and neurosciencesaid, said. “There are a certain set of generic mutations that cancers have and depending on which kind of mutations are present in a given cancer, certain kinds of chemotherapy may work or may not.”

Rafi, who does undergraduate research on cancer at the Robert Wood Johnson Hospital at Rutgers, said that understanding the gene sequence is useful for personalized medicine because it allows for an improved data bank on the individual's susceptibility for certain types of diseases and cancers.

Knowing this susceptibility helps determine which preventative measures are best for a patient, he said. It allows doctors to find new therapeutic measures while understanding the patients' risk levels.

CINJ is doing gene sequencing at Rutgers with the Rutgers University Cell and DNA Repository, DiPaola said. Patients coming through the doors of the CINJ are met by a large team of doctors and scientists who help guide the patients' therapies. Through the partnership with RUCDR, their genes can be sequenced right at the University itself.

“What precision medicine then is, and the way it is benefiting patients, is by using technology to better sort out the individual's medical condition and in our case sorting out their individual cancer using technology — gene sequencing — to really understand their particular situation," he said. "[We can then] tailor the treatment as best possible to make it more effective for them and have less side effects."

There are already some examples in the CINJ where standard therapies for cancer are being done on that basis. One is in skin cancer, melanoma, he said.

A large percentage of patients with melanoma have an abnormal gene, called RAF kinase, that is treatable by a specific drug, he said. The drug does not treat melanoma patients who do not have this abnormality.

“Because of this, that drug is approved as a treatment only for those patients that have that gene abnormality," he said. "More and more, we're finding that the ability to give therapy is based on the genetic abnormalities in the tumor in the individual.”

There is now a national light on CINJ's research and the research of the other NCI designated centers. At his State of the Union address last month, President Obama announced a new national precision medicine initiative, including a $215 million investment towards precision medicine research. 

With the federal government's open support, the precision medicine initiative at Rutgers CINJ will hopefully receive more funding for research and more public awareness and adoption of precision medicine, DiPaola said.

The CINJ is on the cutting edge of precision medicine, he said. Because it is the state center, it is trying to expand to reach patients throughout New Jersey. This way it can sequence the genes and provide effective therapies to more patients.

"I think the more we do that in the clinical research and trials realm. The more we prove the benefits, the more it'll get adopted and that's what we do as a research organization," he said. "We're also a clinical organization, but by being both we bring the cutting edge research right to the patients.”

The CINJ also received $10 million in donation recently and is using the money to work with the hospitals of New Jersey to promote the adoption of precision medicine techniques and technology throughout the state, he said. 

The donation will also position Rutgers as experts in the precision medicine area so the University can be competitive for grant funding as the initiative is put into research dollars, he said.

While the CINJ is based primarily in the New Brunswick area, they are also working with the Rutgers Newark campus to expand cancer research activities there, with the eventual plan of doing precision medicine there as well, he said.

Cancer is an area where more needs to be done to help patients, DiPaola said. New discoveries and research are the most impactful way to do this.

"Precision medicine for me is really exciting and important because that's exactly what that does. You're taking technology and research and applying to patients in real time right now," he said. "We want to have great impact to help patients and get to a cure, and the only way we're going to do that is bringing research right to the bedside.”

Ananth Rao is a School of Engineering senior majoring in mechanical engineering, physics, and computer science. He is a contributing writer at The Daily Targum. Follow him on Twitter @ananthamapod for more stories.

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