MAY 10, 2017 10:30 AM PDT

Delivering on the promise of Personalized Molecular Medicine

C.E. CREDITS: CEU | P.A.C.E. CE | Florida CE
  • Department Chair, Department of Systems Biology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center

      Gordon B. Mills, MD, PhD, was recruited to The University of Texas M. D. Anderson Cancer Center in 1994, where he holds the rank of Professor with joint appointments in Systems Biology, Breast Medical Oncology and Immunology; serves as chairman of the Department of Systems Biology; head of the section of Molecular Therapeutics and holds the Wiess Distinguished University Chair in Cancer Medicine. Dr. Mills is co-Director of the Kleberg Center for Molecular Markers and Director for the Gita and Ali Saberioon Molecular Markers building. This Center is responsible for developing personalized molecular medicine at MDACC. Dr. Mills has published extensively on the molecular analysis of cancer and currently serves as principal investigator or project investigator on many national peer review grants including NIH/NCI SPOREs and PPGs, Department of Defense, and Komen Foundation grants, and is a collaborator on multiple other national grants. Dr. Mills also holds more than 20 patents related to novel technologies and molecular markers and has co-founded an early diagnostics company. He currently sits on the scientific advisory boards of multiple companies and venture capital groups. Based on his expertise in technology development, he is the head of the M. D. Anderson Cancer Center Technology Review Committee.


    The realization of the promise of personalized molecular medicine requires efficient development and implementation of novel targeted therapeutics linked to molecular markers able to identify patients most likely to benefit. An efficient integration of DNA, RNA and protein information content will be needed to identify patients likely to respond to particular therapies. The plethora of aberrations present in each tumor, the need to distinguish drivers from passengers, and the combinatorial effects of aberrations on critical cellular functions represent key challenges. The overall likelihood of response to therapy represents the interaction between predictors of sensitivity and predictors of resistance. Resistance can be pre-existing, adaptive, or acquired. Resistance can also occur through heterogeneity of molecular changes within the tumor and metastases. Adaptive resistance, which is the consequence of activation of homeostatic loops and phylogenetically conserved stress responses, provides a potential therapeutic liability that can be leveraged for rational combinatorial therapy. Thus a comprehensive analysis of patient tumors before, during and after treatment should become the standard of practice. Testing these precepts will require the development and implementation of novel trial designs. It is likely that we will need to increase the size of phase I and II trials to allow the identification and validation of molecular markers at the same time as the initial evaluation the toxicity and efficacy of targeted therapeutics. This will come with the advantage of much smaller phase III trials of patients selected for the likelihood to respond accelerating the approval of effective targeted therapeutics. 

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