When Will Genomics Cure Cancer?

A conversation with the biogeneticist Eric S. Lander about how genetic advances are transforming medical treatment
Sébastien Thibault

Since the beginning of this century, the most rapidly advancing field in the life sciences, and perhaps in human inquiry of any sort, has been genomics. In 2001, rival teams from the Human Genome Project and the private company Celera each announced a draft sequence of the human genome—a map, essentially, of the 3 billion letters of DNA that make up a human being’s genetic code. Eric S. Lander was one of the leaders of the public project. Now a professor at MIT and Harvard Medical School as well as the director of the Broad Institute in Cambridge, he discusses what researchers have learned since then, and how they may soon convert many forms of cancer from fatal afflictions to manageable chronic diseases.

James Fallows: Everyone has heard about remarkable breakthroughs in genomics, but it is hard for nonscientists to put them in perspective. By analogy to aerospace, are we still at a stage like the Wright brothers’? Or are we landing on the moon?

Eric S. Lander: A good analogy is the germ theory of disease. There was a sweep of progress from the fundamental understanding around 1870 that microbes caused infectious diseases, to the widespread availability after World War II of cheap penicillin that saved millions of lives. That took about 75 years. With genomics, we’re maybe halfway through that cycle—something like the situation around 1915, when early, highly imperfect antibiotics were first introduced.

JF: What are the comparable next steps in genomics?

ESL: Before we could understand the genetic basis of inherited diseases and cancer, we first had to get a sequence of the human genome. The first 15 years of work [on the Human Genome Project], and about $3 billion of cost, was devoted to getting one sequence of one human being, to use as a starting reference point.

The next job was to go figure out how people with a disease, whether it’s diabetes, schizophrenia, or a lung tumor, differ from that reference. That would require looking at the genomes of thousands and thousands of people to spot the changes. Remember that it took 15 years and $3 billion just to get the first person’s sequence. The idea of doing that thousands of times over would have seemed crazy—except that an amazing transformation over the past 12 years brought down the cost of sequencing genomes by about a million-fold. That has allowed us to look at thousands of people and see the differences among them, to discover critical genes that cause cancer, autism, heart disease, or schizophrenia.

For the first time, after 25 years of genomics, we can finally pop the hood on the car and see what’s wrong. The rate of progress is just stunning. As costs continue to come down, we are entering a period where we are going to be able to get the complete catalogue of disease genes. I think in another five or six years, we should have a complete catalogue. That is not a cure for disease. The next level will be seeing how these individual genetic components fit together, into circuits. You could say that right now we are discovering all the parts of a Boeing 747 and meticulously laying them out on the floor of a hangar. That’s actually pretty impressive, to get all the parts! Still, the plane doesn’t fly yet. This next generation of young scientists is figuring out the functional circuits into which all these parts fit.

JF: I feel lowbrow asking this, but on what timeline will patients see the results? Are these therapies decades away, or a few years?

ESL: It’s important to define your goals. Therapeutic development has already been transformed by genomics. There are 800 different anticancer drugs in clinical development today. Cancer drugs used to be just cellular poisons, but almost all of these new ones are targeted at particular gene products that have been discovered.

But it’s just a start. Some of the new cancer drugs can miraculously make tumors disappear. The problem is that, a year later, the cancer in many cases comes roaring back, because some of the cells have developed mutations that make them resistant. So genome scientists are now finding and targeting these mutations as well. Remember in the 1980s, when HIV was a fatal disease? What made it become a chronic, treatable disease? It was a combination of three drugs. Any one of those drugs alone, the virus could mutate its way around. But with the combination of all three, the chance that a virus could find its way around all of them was vanishingly small.

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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.

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