Editor's Note

Blue Skies Ahead

Precision medicine is making strides in melanoma treatment.

By Jeanette McCarthy, MPH, PhD

Like many people, I enjoy spending time outdoors in the summer. When it comes to wearing sunscreen though, I admit I’m not as diligent as I should be. Maybe it’s because I grew up in a time when baby oil was an acceptable tanning agent. As a young girl, I remember watching commercials on TV advertising cocoa butter for a deep dark tan and decided to see if regular butter would do the trick. When sunscreen with SPF was introduced, I really didn’t understand it. I would debate with my sister at the beach about the amount of protection you get when you mix an SPF 4 sunscreen with an SPF 15 sunscreen. Maybe my lax attitude about sun block is because, with an olive complexion and no family history, I don’t perceive myself to be at risk of skin cancer.

Surely a number of factors contribute to whether someone adheres to health behaviors aimed at reducing their risk of disease. Last year, a large study of more than 700 people conducted by the Coriell Institute for Medical Research in Camden, New Jersey, found that genetic risk information was significantly associated with sun protection behaviors, especially in cases where family history is incomplete.

Genetic predisposition testing is only one way in which precision medicine can impact the management of melanoma. In this issue of Genome, we take a deep dive into melanoma precision medicine, exploring advances in diagnosis and targeted and immunotherapy treatment options. (See “More Skin in the Game,” page 56.) At a recent conference I attended, melanoma was also the subject of another type of treatment — cancer vaccines.

Cancer vaccines are based on our understanding of cancer at the molecular level. By sequencing tumors, we can identify proteins expressed in the tumor but not in normal tissue. These proteins (also called antigens, or neoantigens) become targets for treatment using therapeutic antibodies designed to specifically attack these targets. While targeted treatments have been shown to improve outcomes in cancer patients, in most cases, the cancer recurs.

In the current issue of Genome, we take a deep dive into melanoma precision medicine, exploring advances in diagnosis and targeted and immuno-therapy treatment options.

But researchers are developing other treatment methods that harness the immune system to attack cancer. The immune system is pretty good at recognizing anything foreign (not “self”) and attacking it, for better (pathogens) or for worse (organ transplants). As tumors grow and acquire genetic changes, they begin to look more and more foreign, and yet the immune system is kept in check. Immunotherapies help release the brakes on the immune system so that it can recognize and attack tumors as foreign. Knowledge of the specific neoantigens that are expressed in a patient’s tumor and make the tumor look foreign can improve immuno-therapy response even more. These neoantigens are identified by sequencing the tumor. Then they are used to train the body’s T cells (a type of white blood cell central to the immune response) to attack the tumor. These cancer vaccines have begun to show promise in clinical trials and represent an exciting development. We will explore cancer vaccines in more detail in a future issue of Genome.

Genome magazine is well into its third year of publication, and based on a recent survey of our readers, the magazine is achieving its goal of bringing the science of genomic and precision medicine to the general public. We heard from nearly 500 of our readers (thank you). Nearly half of the respondents were healthcare providers! According to the survey, Genome readers are most interested in targeted treatments and technology. Readers are also curious about the microbiome and epigenetics, and want to learn more about cancer, mental health, autoimmune disorders, and healthy aging. We will continue to present developments in these areas to our readers, capturing the clinical as well as social aspects. (See this issue’s stories about family dynamics, page 32; privacy, page 36; and paying for precision medicine, page 40.)

Like many people, Genome readers seek health information from the internet, most commonly through sites like WebMD or the Mayo Clinic, both of which cover general medicine. Genome continues to be the sole source focused on genomic and precision medicine. About a third of our readers have talked to their healthcare provider about a story they read in Genome, and a third have also explored their DNA through direct-to-consumer genetic testing.

It is our intent to educate and engage our readers, and above all, to be a trusted source of scientifically valid information on genomic and precision medicine. We’d like to thank our readers for their feedback and support as we continue to fulfill our vision of a world in which everyone knows the power of his or her genome.