We are cancer researchers Adam Marcus, PhD, and Suresh Ramalingam, MD, ask us anything about cancer and the future of personalized cancer medicine!

I don't have a question, but thanks for what you guys do.

Thank you, appreciate it!

How is genomics cracking the code on a cure for cancer?

Great question! It is making a huge difference. Just wrote a post about it here http://www.notamadscientist.com/2014/05/12/cracking-cancers-code-to-unlock-new-treatments/

what is your take of using viral therapies like measles?

Immunotherapies have become hugely popular now and have had some great success. The measles story just came out and I think more work needs to be done.

I've heard a little about using blood tests to detect early signs of cancer; do you know how far off this is to being more routinely used?

This would be a great advance. Many researchers are studying this concept since it would be much less invasive. The ability to catch cancer early would be key for any type of cancer.

I had this idea today. I wonder if it's completely ridiculous.

If I have a certain specific kind of cancer, would it be possible to find another person who is not related with the exact same kind of cancer, extract their cancer cells and immunize me with them? Perhaps it would stimulate the "not self" part of our immune system enough and sensitize the immune system to aberrant/different cell-surface proteins expressed in the cancer cell.

I would not say it is ridiculous. I think the problem would be that cancer cells from your body can evade the immune system quite well even if it had seen similar cancer cells from someone else

With recent advances in medical science coming to lot, do you feel that treatments for cancer are drastically improving and how promising do you view future treatment technologies? Also, what is your position on Cannabis as a treatment for cancer (especially lung cancer)?

Yes, there are definitely new opportunities for treatments that should happen in the next few years. I speak about some of these in my blog notamadscientist.com. Briefly, the ability to rapidly sequence DNA in the tumor, will change how we treat it. This is a major new direction and will likely improve our understanding and ability to treat.

Well, first off, thank you for your time. I am very glad to hear that you find future technology promising, if you have time and don't mind answering; how exactly will rapid DNA sequencing change patients treatment options?

Just wrote a blog post to help answer this, see http://www.notamadscientist.com/2014/05/12/cracking-cancers-code-to-unlock-new-treatments/

Are you a mad scientist?

I feel like you have asked me this before? :)

Is there anything you suspect to cause cancer, but has not been proven or studied?

The jury is still out on cell phones but this is a very tough study to do since it happens over so many years of exposure

Thank you for what you do...both of you! If you are still around...go give my mom (judy) a high 5. She is at Emory right now on the 8th floor e wing. The staff y'all have there is amazing! Do you think that Emory will do research with the measles vaccines in regards to Multiple Myeloma?

Thanks for the message!

what are the mainstream myths about cancer that we should learn to not worry about?

The majority of cancers are not inherited at least from what we can tell. There are some types that are inherited but they are the minority.

The biggest myth running around right now is that screening and treatment allow people to "beat" cancer.

That logic may work when it comes to bailing water out of a sinking ship. But when it comes to human health, the best approach is to not get sick in the first place.

Yes prevention is definitely key. Sometimes even the best preventative measures are not foolproof and catching it early does make a big difference.

I'm currently revising for my finals, and this is PERFECT. How far has personalized medicine come in terms of cancer therapies, and how soon do you think we can expect to see these widely available? Also, do you know of any good journals etc. that help on the subject?

Some personalized med. is already being rolled out. Take a look at ALK in lung cancer, herceptin in breast cancer. Good journals are Cancer Research and also some pop. science journals. Some good info on Twitter too.

if tissue rejection can be solved, what are the other complications of simply replacing all cancerous tissue with replacement healthy tissue as a catch-all solution?

The problem is that the cancer can spread so replacing all the tissue is very difficult. If a few cancer cells are left behind it could have serious implications

What developments are you most excited about?

Immunotherapy seems very promising, personalized medicine in general where specific mutations are being targeted. I also am very interested in anti-metastatics

Is there hope of any breakthroughs in DIPG treatment? Or will it just always be terminal on daignosis

Gliomas in general are tough. IMO we need to better understand the biology behind how they spread to make more progress. Also, sequencing these tumors should have an impact and reveal new info.

When companies/fundraisers say they are raising money for cancer research… do you actually get the money, and does it help? Even if it is only a few thousand - I have the impression you need a bagillion dollars to make a difference.

Yes, in most cases that I am ware of the money does go to the labs. To be honest, every bit counts!

How long have you been working in the field and what's your salary like?

Been doing cancer research for about 12 years

What do you think about the latest news about "cancer stem cells" found?

There's a lot of conflict within the cancer research community about "cancer stem cells." Some groups prefer the term "tumor propagating cells." It's still very much a fuzzy term. It'll take a lot of time and research before we (the scientific community) really even know what we mean when we refer to "cancer stem cells."

Yes completely agree

Personally, I hate that "cancer" is a common term thrown around. So many of them are so different from each other. Is there a few categories of cancers that can easily refer to different types of cancer?

Cancer is not one disease. For instance, lung cancer behaves differently from one patient to another. As this becomes increasingly clear, we are now relying on genetic markers in the cancer to predict the behavior and select treatments for each patient on an individual basis.

So are there any convenient labels for these different types of cancers?

For a long time we used where the cancer started (e.g, lung cancer, breast cancer) but in the future we will start use genetic labels based upon the mutations in the tumor.

I'm extremely interested in both medicine and research, however I'm not sure I want to spend 8 years in an M.D./Ph.D. program. How long is a normal period of time after your Bachelors to spend getting your advanced degree? How did you get to where you are? Thank you for your AMA!

I'm an MD/PhD student at Emory & Georgia Tech, and can vouch for Dr. Adam Marcus being a boss. I'll try to provide some useful info here.

After finishing college, you can do an MD (4 years) or a PhD (3-8 years, average is 4-5 for a biomedical science field).

For MDs and MD/PhDs, most are encouraged to complete residency training. For hematology/oncology like Dr. Ramalingam, this entails 3 years of internal medicine and 3 years of fellowship in hematology/oncology. When you finish residency and/or fellowship, you can apply for faculty positions at an academic institution where responsibilities might involve seeing patients, performing research (e.g. grant-writing and supervising trainees), and teaching students.

For PhDs, post-graduate training usually involves 1-2 postdoctoral fellowships followed by applying for an academic faculty job.

There are many non-academic careers for MDs and PhDs interested in the scientific enterprise. Biotechnology firms, startups, and consulting are all attractive and meaningful careers.

More articles specific to MD/PhD training:

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2003_10_03/nodoi.9724399671948641535

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2003_10_03/nodoi.16025480221817701387

Thanks Erik!

Do you believe there is a cure for cancer that doesn't involve spending an arm and a leg on treatments?

I hope so, usually the simplest solution is the best. We are trying to use natural products as one aspect of treatment. It still needs a lot more rigorous testing to know if they really work in combination with traditional treatment.

I'm currently studying cell biology; is it possible for implanted stem cells to 'go rogue' and turn cancerous if they are not processed correctly?

In theory, I guess it would be possible. Usually cells go rogue over many decades, which is what typically happens in most cancers. Stem cell implants are so new that we are not entirely sure how this will pan out.

How do you see genome sequencing affecting cancer treatment in the near future? Will it become standard to sequence a tumor's genome? How would you use this information to treat patients?

Yes, this will totally change. See my recent blog post on this exact topic notamadscientist.com

Thanks for the info, read the blog post but was hoping for a bit more scientific detail. How is the genomic information used specifically? Do you figure out what proteins the tumor DNA codes for, then design a drug that binds to those proteins? Also, from the blog post, it sounds like you would still be grouping patients into "bins" of types of cancer (albeit a lot more of them than there are now), rather than treating each cancer as unique, is that correct? In that case, it seems more like you would be looking for specific known markers in the tumor genome and using them to find already invented treatments rather than using the entire tumor genome?

These are great questions. Be happy to answer then offline. Can shoot me an email from my blog. What will likley happen patients will be grouped into "bins" based upon genetic makeup of the tumor (e.g., driver mutations). Right now most patients are grouped based upon the tissue of origin of the tumor. Also, most drugs bind to the proteins and this will likely still be the cases However, we will know which proteins have gone bad and target those specifically. Seems logical but easier said than done. Perhaps, as you mentioned, older treatments can be brought back.

I do not know if you are familiar with NMTRC (The Neuroblastoma and Medulloblastoma Translational Research Consortium) work with genomic guided therapy, but I'm wondering if you are work is similar?

Has smoking bans in public areas affected lung cancer rates?

Do you have any lung cancer pediatric patients?

We are trying to use genomics to sequence lung cancer tumors and then treat it in a much smarter way ,which I believe would have similar goals as NMTRC. Shameless blog plug about this- http://www.notamadscientist.com/2014/05/12/cracking-cancers-code-to-unlock-new-treatments/

Do you feel like progress is being made on cancer research in any significant way proportionate with how much money is invested? Or do you think not much would have changed if billions weren't poured into research every year?

Yes, honestly I believe there has been significant progress but I also feel like there will be big positive changes in the next 5 years. Also, without the money none of this would have happened. Just like anything else, it is about hard work, perseverance, and opportunity.