Physicians historically have had little patient-specific disease information to guide their treatment decisions, and many patients have suffered through ineffective treatments -- and their side effects -- in an effort to discover what works for them.

But thanks to information gleaned from sophisticated genomic analyses, Duke Medicine is now delivering disease-specific treatments to patients enrolled in clinical trials currently under way here.

For example, patients with advanced non-small-cell lung cancer are taking part in a first-of-its-kind study led by Duke oncologist Jennifer Garst, MD. The study -- based upon the research of Joseph Nevins, PhD, and Anil Potti, MD, both of Duke’s Institute for Genome Sciences & Policy (IGSP) -- uses genomic analysis to guide the choice of the initial chemotherapy drug patients receive, when an effective treatment is particularly critical.

Because every person’s genetic composition is unique -- and that composition influences both normal and abnormal cells -- diseases are as individual as the people who have them. Herein lies the key to the pioneering field of genomic medicine.

For patient Artis Perry, 64 -- who was diagnosed with Stage 4 non-small-cell lung cancer in Spring 2007 and chose to participate in Garst’s study -- the genomic-guided approach couldn’t have worked better.

After a genomic analysis found Perry’s tumor to be resistant to cisplatin, a commonly used front-line chemotherapy drug, he was assigned to a treatment group using a combination of the non-platinum drugs pemetrexed and gemcitabine. At the end of Perry’s six-cycle treatment, his tumor was more than 50 percent smaller.

Because Perry received the initial treatment that his tumor was genetically wired to respond to, he didn’t have to waste precious treatment on fruitless therapies or endure side effects of drugs biologically destined to be ineffective. Had he been prescribed the “standard” drug for his condition with no consideration of his genetic makeup, his post-chemo outcome likely would have been much different.

In early 2008, the trial will be expanded to the Duke Cancer Center Raleigh based at Duke Raleigh Hospital. A range of other novel genomics-guided clinical trials -- all carried out by the Duke IGSP’s newly formed Clinical Genomics Studies Unit under the leadership of Geoffrey Ginsburg, MD, PhD -- will soon begin at Duke and several Duke-affiliated hospitals, giving patients with other types of cancer the opportunity to benefit from similar targeted therapies.

For example, Duke oncologist P. Kelly Marcom, MD, will soon launch a large clinical trial to investigate genomic-guided therapies in early-stage breast cancer patients. Supported by a $7-million grant from the U.S. Department of Defense, the trial will seek to confirm that genomic profiles can be used to successfully predict which patients will benefit from which existing chemotherapy drugs.

Similar studies involving patients with other types of cancer will begin at Duke in the near future. To learn more visit www.genomestohealth.org.