A California-based company is attempting to introduce
expert crowdsourcing to oncology to try and ensure that each
cancer patient gets the most appropriate treatment.
Commons brings together leading physicians and scientists in
each type of cancer to create an open-source wiki-style database
that will catalogue the different genomic subtypes of each disease
and show how patients are responding to different treatments.
The project is based on the hypothesis that every
patient's tumour is, to some extent, unique. Although most
cancer drugs are tested individually in large-scale clinical
trials, the majority of physicians (70 percent) prescribe cocktails
of drugs based on their individual experience and particular
genomic subtype of the cancer. By capturing, aggregating and
analysing the genomic and results data of these individual drug
experiments -- cross referencing them with the large scale clinical
trials and studies -- physicians might be able to more efficiently
find the most appropriate treatment for their patients.
Cancer Commons was set up by Jay "Marty"
Tenenbaum -- a Silicon Valley entrepreneur and
cancer survivor who founded a range of e-commerce companies
including CommerceNet and Veo Systems. He also
founded Enterprise Integration Technologies, the first company
to conduct a commercial internet transaction, in 1992. More
recently he has focused on transforming healthcare, launching CollabRx, which uses computers
to personalise cancer treatments and accelerate research (and which
powers Cancer Commons).
Tenenbaum argues that there are thousands of studies that are
published each year, with only a handful of them getting national
or international attention. Furthermore, there are hundreds of
thousands of individual "trials" being conducted by doctors (some
30,000 oncologists in the US, where the program is limited to for
the time being) who are experimenting with different cocktails of
drugs on their patients. Without one central place to store
and access these studies, scientific and clinical advancement in
this field is being artificially held back.
A major hurdle for the project is getting researchers to supply
their data to the site, rather than hold out for a career-making
article in a peer-reviewed journal. Tenenbaum is frustrated by how
little data is shared between peers and hopes that Cancer Commons
could mark the dawn of a new era of open-source science.
Tenenbaum told Wired.co.uk: "There is lots of talking in
fragmented silos, but we want to capture all of that in one place
and expedite the process through which science turns into
The first stage of Cancer Commons is to create a database where
each different type of cancer has a "Molecular Disease Model" (MDM)
-- an expert-curated reference node that catalogues the known
molecular subtypes of a particular cancer, linked to relevant
pathways, diagnostic tests, approved and experimental therapies and
current clinical trials. Each is akin to a dynamic research paper
that reflects the latest scientific, clinical and technological
advancements. A rapid submission and dissemination process allows
each MDM to be maintained online and continuously updated by cancer
specialists and moderated by editors.
The project is governed by an editorial board with an impressive
set of credentials. The 18 specialists -- chaired by George
Lundberg, former editor-in-chief of Journal of the American Medical
Association and of WebMD's online properties
and e-Medicine --
include a former FDA Commissioner, a former editor of
Science and a former president of the American Society of
So far, only one model has been created, for melanoma. It
incorporates 78,185 abstracts from research papers and information
relating to some 1016 clinical trials that are ongoing in the
field. Some 11 expert editors have been assigned to that particular
MDM, including Dr David Fisher, the head of the dermatology at
Harvard Medical School and Dr Keith Flaherty, from the department
of medicine at Harvard Medical School. Over the coming year the
plan is to create MDMs for other cancers including lung, breast,
sarcoma, and lymphoma -- each with their own experts overseeing
In order to harness the power of the MDM, CollabRx is developing
apps that tap into the data to aid decision-making. For example,
the "Targeted Therapy Finder" can be used by doctors to help
identify genetic tests that map an individual tumour's unique
characteristics, and then select potential treatments based on the
findings. By entering information about the particular tumour,
they'll be given options of tests that'll help narrow down the
particular subtype of cancer being dealt with (as categorised by
the MDM), and therefore find out which treatments are the most
promising. They can then find information about trials that are
looking for patients with that particular subtype.
The view is to develop further apps that allow doctors and
researchers to submit clinical observations and outcomes and then
collaboratively analyse them to fine-tune the MDMs. Tenenbaum would
also like to see patients report how they're responding to
treatments. He tells Wired.co.uk: "Over time I'd like the
results of lab tests to go directly into the database."
He doesn't underestimate the enormity of the task, admitting
that not all of the details are worked out yet and that the initial
MDMs will "almost certainly be incomplete and wrong in places". He
adds: "We don't pretend that we are going to cure cancer. But we
ought to be able to improve the outcomes for some patients."
Tenenbaum wants to make applications that are so compelling to
doctors that they'll have to use them to stay relevant in their
fields. "I see possibilities to slash time and development of new
drugs and improve patient care."