Support for Duke breast cancer colleagues post-Potti

I came home yesterday and looked at the mail with a shudder: the Summer 2010 issue of the biannual Duke Medicine DukeMed magazine greeted me with a cover on personal genomics in breast cancer.

Oh no.

As a twice-yearly publication, it was probably published weeks ago and was sitting in a warehouse ready for mailing. All this while when The Cancer Letter broke the story about credentials issues surrounding Dr. Anil Potti and raised awareness of widespread criticism in the field surrounding work from him and Dr. Joe Nevins on genomic signatures and drug sensitivity of patient tumors (our post with links to reports here).

Indeed, Potti and Nevins were still quoted therein (article text here, full issue 4 MB PDF here):

“Genomics will revolutionize cancer therapy,” says cancer researcher Anil Potti, MD. “It allows us to identify a fingerprint that’s unique to every individual patient’s tumor. If you can match that fingerprint with the drug that’s most likely to work for that patient, you can make cancer treatment more effective and less toxic. It brings us closer to a cure.”

Potti and Joseph Nevins, PhD, of the Duke Institute for Genome Sciences & Policy, have led the effort to look at gene expression profiles from large groups of tumor samples and compare those profiles with treatment outcomes, searching for patterns (or genomic signatures) that indicate the “personality types” of tumors — those that are likely to metastasize or not; those with good prognosis and poor prognosis; a tumor that is resistant to a drug or one that is sensitive to a drug.

But the vast majority of the article featured several other Duke oncology physician-scientists with quotes and profile photographs on other efforts there to personalize breast cancer treatment. Several of these folks are colleagues who I respect deeply and whose scientific ethics and clinical dedication are beyond question – all are tremendous physicians who’ve relieved the suffering of thousands of women with breast cancer (perhaps a couple tens of thousands – and a couple of hundred men with breast cancer as well.)  One I recognize as a heme/onc fellow I taught in an AACR laboratory workshop over 10 years ago.

Just as many of my esteemed colleagues in the pharmaceutical industry are tarred with sweeping generalizations following high-profile but individual cases of unforgivable impropriety, I fear that some of my valued Duke colleagues may be similarly viewed by the broad public.

I recognize that the pending internal and external investigation of the Potti case may reveal some collusion of institutional leadership and culture.

However, I wish to register my personal and professional support for my other Duke colleagues quoted in this issue of DukeMed.

If my mother had a recurrence of her breast cancer or could gain access to an experimental treatment in a clinical trial outside of those based on Potti’s science, I would still send her there in a heartbeat.

Disclosure: I was co-author with one of the named physician-scientists on a 2004 Journal of Clinical Oncology case report of a breast cancer patient who experienced a delayed-hypersensitivity reaction during chemotherapy following injection of a mistletoe extract by a naturopath. Another co-author was my spouse, a former Duke physician-scientist. Since 2001, I’ve also held an adjunct faculty appointment at Duke and am a member of their NCI comprehensive cancer center. I draw no salary or other compensation from these appointments.

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