Cancer Commons is being developed one cancer at a time. At the core of each Commons is a Molecular Disease Model (MDM), a curated reference model enumerating the known molecular subtypes of that cancer, hyperlinked to relevant pathways, diagnostic tests, approved and experimental (targeted) therapies, and clinical trials. At each point in time, oncologists can use the appropriate MDM to treat patients with the best available therapies for their tumors’ molecular subtype. The subtypes and associated therapies are then continually refined based on how individual patients respond. For example, subtypes can be split corresponding to responders and non-responders, and new subtypes added to accommodate previously unseen tumor types. The MDMs thus serve as living review articles, maintained online and continuously updated by top cancer experts.
Clinicians and researchers will also be able to post peer-reviewed clinical observations and data, anecdotal case reports, rational treatment hypotheses, and actionable research findings to the relevant MDM subtype, which are too early for formal presentation in journals or at conferences, but may be helpful to late-stage patients running out of options. Physicians and patients who choose to act on these postings can then report clinical outcomes and side effects from their “N of 1″ experiments through the Web. Treatment hypotheses that prove successful in a few patients can be generalized to a specific molecular phenotype, and validated in proof of concept studies or small clinical trials. If they hold up, they can ultimately get incorporated into the guidelines as the new standard of care. Hypotheses and observations that don’t hold up can be quickly rejected or revised based on the data points from human subjects.
The development process for Molecular Disease Models involves recruiting the editorial advisory members, creating the model, and developing web-based applications for doctors, patients and researchers that make it easy for each of these stakeholders to interact with the model — selecting tests and therapies for patients, reporting outcomes, collaboratively analyzing the results, and updating the model. We are now standardizing this process and will be applying it over the next year to other cancers with high unmet needs, in partnership with disease foundations, collaborative cancer research initiatives and pharmaceutical companies.
