Oregon’s precision medicine pioneer targets earlier cancer detection

OHSU Knight Cancer Institute Director Brian Druker talked with Medscape Editor-in-chief Eric Topol about breaking out of one-size-fits-all thinking in cancer screening and prevention.

“We are now in the process of building an entire program on what I call precision early detection of cancer,” said Brian Druker, M.D., “We are trying to be more accurate in taking the same precepts of precision medicine for advanced cancer and using them earlier.”

If it works, Druker told Medscape’s editor-in-chief, Eric Topol, M.D., the early detection initiative at OHSU will find a way out of the big conundrum of cancer screening: technologies that too often fail to find dangerous cancers while at the same time raising too many alarms about essentially harmless tumors and driving overdiagnosis and unnecessary treatment.

Topol pressed Druker on a range of tough issues: evidence that some cancers can spread very early, possibly making early detection infeasible; the nearly inevitable relapses that have limited the success of targeted therapies other than Gleevec; the increasing unaffordability of cancer drugs.

There are no easy answers, but Druker told Topol that we have reasons to be optimistic about what cancer treatment and prevention will look like within the next decade:

The analogy I use is, what if we turned the clock back 100 years and looked at infectious diseases? Over the past century, the 1900s, we had public health measures like chlorination of water and pasteurization of milk. Those are preventive [strategies]. We brought along antibiotics, which are targeted therapies. We brought along vaccinations, and polio and smallpox were eradicated. If people took vaccines, then mumps, measles, and many other infectious diseases would be essentially eradicated. That’s immune therapy. Zika comes along, HIV comes along—certainly we have not completely eradicated infections, but we do not fear them. If you go to the doctor with pneumonia, [it’s] “what antibiotic do I take?” In 1900, that was a death sentence. That’s what I see for cancers. It’s a broad-based approach. It will be more genomically based therapies. It will be prevention and early detection, in a precision-based way. It will be immune therapies in a precision-based way. Then cancer will no longer be a feared, dreaded disease.

You can watch a video of the full interview or read the transcript online at Medscape.com.