On Target
A new generation of drugs offers customized cures
The two women, on opposite coasts, have led very different lives. Ginger Empey of Bakersfield, Calif., can no longer work. Gloria Caruso is an airline reservation agent in Tampa. Caruso, 63, is married; Empey, 58, divorced. The women have also struggled with two different illnesses. Empey has battled breast cancer that spread to her liver, while Caruso fought lung cancer that spawned tumors in her neck and back.
But the two also share some good fortune, including joy in their grandchildren. Empey was amazed over the Christmas holiday to see that Liam, 7, had shot up to over 5 feet tall. And Matthew, 5, delighted Caruso by appearing as a reindeer in a play. "You really haven't lived until you've seen little kids put on a musical, yelling, `Hey, Mommy' in the middle of a song," she says. The women also share in a medical revolution that has made such moments possible for them, a revolution known as personalized medicine.
Unlike the shotgun strategy of most drugs on the market today, new drugs can be tailored to fit an individual patient with a particular disease. Empey is taking Herceptin, a drug that homes in on tumor cell proteins that flourish only in patients who have her specific subtype of breast cancer. Just last month, a study showed that the medicine kept the disease at bay for an unprecedented 14 months. For Empey, it has already added nearly eight years to her life. Iressa, the drug that has allowed Caruso to hear her reindeer sing, focuses on another protein that has been found in abundance in certain lung cancers.
"This is a revolution in drug use," says Edward Sausville, associate director of developmental therapeutics at the National Cancer Institute. "Now we can use the biology of the disease, the genetics, to see a target in a patient. This is a lot different from the old mind-set." Doctors used to assault an amorphous disease with a blunt instrument, like a chemical selected for its ability to kill lots of cells in a lab dish. That's a far cry from using the individuality of genetics.
Matchmaking. The revolution extends beyond cancer and beyond the development of new drugs. It includes new tests that can better match patients with existing drugs, improving the chance of good results and avoiding toxic side effects. Gene tests can now reveal whether an organ transplant patient is likely to have a bad reaction to a particular transplant drug, forewarning doctors about the risk. A commercially available gene test can identify patients in danger of severe bleeding if they take the anticoagulant warfarin. And tests under development can pick out people who have both good and poor responses to drugs for high blood pressure, which should allow doctors to match patients to the most suitable drugs in advance. Taken together, these discoveries lead Dennis Slamon, who pushed the development of Herceptin while an oncologist at the University of California-Los Angeles, to this pronouncement: "The one-size-fits-all approach doesn't work anymore. Targeted medicine is the future."
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