Precision medicine or precision oncology means treating a person's cancer according to the genetics of that individual's cancer.

This is important because there are many types of cancers, and a cancer that someone has can also change over time, for example, adapting to become resistant to drugs.

This characteristic of cancers often cause a chemotherapy drug that initially works to stop working.

SMMART's goal is to discover and tailor treatments for each individual patient, in anticipation of a cancer's ability to change and resist treatments. The treatments prescribed are updated over time so that they remain effective.

You can learn more about the history of precision medicine at OHSU, and read more about precision oncology at the National Institute of Health. 

SMMART stands for Serial Measurements of Molecular and Architectural Responses to Therapy. We call it this because we take repeated, or serial, measurements from each patient, over time. The serial measurements allow us to best understand each patient's cancer in great detail, and also to best individualize the treatments we prescribe for each patient. 

Official study information about the SMMART clinical trial is available through the Knight Cancer Institute's clinical research database page about the SMMART clinical study. 

For more information, contact Swapnil Parmar, parmar@ohsu.edu, or 503-494-9642.

A tumor board is panel of experts that meets to review and discuss the imaging and lab results for a patient's cancer biopsy. Together, they determine what treatments will be prescribed for that patient's case. For the most challenging cases at OHSU, tumor boards meet as often as every two weeks. 

In the SMMART clinical trials, two tumor boards meet every other week to discuss findings and work together to recommend the best treatment approach for each patient. 

In SMMART, the two tumor boards who review your case include a clinical board, or one comprised of doctors an scientists with specific clinical expertise in cancer medicine, and another that discusses mechanisms of resistance, comprised of researchers who know the most about how the drugs work in terms of genetic and cellular mechanisms. 

Unlike other clinical trials, which are usually designed to make simple comparisons or analyses, SMMART is designed to be as comprehensive as possible about understanding and treating your cancer.

This includes taking biopsies more than once, if necessary, and also taking blood samples weekly, then doing extensive testing on the blood and tissue samples.

The repeated measurements will allow us to best understand why and how the drugs are working or not working as hoped, and whether the treatment can be better optimized.

Measurements include:

• Imaging of various types, including at very high resolutions (electron microscopy) so that even the smallest (microscopic) features of individual cancer cells can be assessed.
• Omic profiling, or the full determination of the exact composition of your cancer's DNA, RNA, proteins and other biomolecular information. This is known as omics because it is the composite knowledge of all the following types of analyses:
  • DNA profiling is known as genomics.
  • RNA profiling is known as transcriptomics.
  • Protein profiling is known as proteomics.
  • The analysis of modifications to the DNA, which help turn genes on and off, or affect gene expression, is known as epigenomics. 
• Biomarker assessment from the patient blood samples. Because biomarkers yield information about a cancer without requiring more than a blood sample, they are valuable because they are a less invasive way to assess how a treatment is working. Fewer biomarkers tend to mean the cancer is dying. No biomarkers may mean the cancer is gone or almost gone. Learn more about biomarkers.