On a recent visit to 23andMe George Demetri –a physician and scientist who is an unpaid advisor to our Sarcoma research initiative – sat down for a short interview after talking to our team. Demetri, who is also director of the Dana-Farber Center for Sarcoma and Bone Oncology, said he has a lot to be optimistic about in the study of sarcoma. Individually these are rare kinds of cancers affecting the bone as well as cartilage, muscle and other soft connective tissue in the body.Demetri’s work at the Dana-Farber’s Center offers much to be hopeful about. Demetri, who has had his share of practice-changing clinical breakthroughs, mostly notably with treating gastrointestinal stromal tumors, is excited by some of the preliminary research 23andMe is already compiling around our Sarcoma research community. He said the model for our research platform – crowd-sourced, Internet-based and web-driven genetic studies – is something he has long envisioned as a way to improve medical research and treatment. 23andMe: You anticipated using the Internet to connect patients to doctors and researchers long before 23andMe created its Sarcoma Community. Where did that idea come from and how does 23andMe’s work mesh with what you’d hope to see? Demetri: For me the whole idea of using the Internet was about finding the right patients who have the disease under interest because it was very clear that the tools we use to diagnose a disease are not sufficiently powerful … cancer it’s not one disease. Sarcomas under the microscope look very different. When we start diving into the chromosomes they were completely different. And when we started diving into the genetics they couldn’t be more different … (W)hen you peer into that looking glass you see that there are a thousand different kinds of sarcomas. You run into a problem if they are only one percent of all cancers and you have 1,000 different diseases, there are not a lot of people with any one kind of those cancers … You have to do the E-Harmony trick. You have to match the right patients to the right drugs. 23andMe is the perfect tool for that. Nine out of ten cancer drugs we have today fail in clinical trails and that’s because nobody’s paying attention to this important matching of what’s driving the patient with the cancer to the drug that works for that cancer. To do that you need to put another filter on the traditional clinical trials methodology where you don’t just take everybody who walks in the door with a given type of cancer. Instead you take the patients with the right kind of genetics and you actually select for them. It’s the same kind of issue that patients have. They want their medicine personalized. And you know we hear a lot of backlash about this in the medical community where they are saying: “You guys in academia talk a lot about personalized medicine. Well, I’m very personalized. I treat my patients as individuals.” And you know they do. They do the best can with old technology and old diagnostic, but the truth is our technology has moved beyond that and patients want access to it. 23andMe: What might the work on Sarcomas mean for other kinds of research? Demetri: Sarcomas tend to be driven by one dominant pathway, where if you shut it off the cancer gets better. GIST (gastrointenstinal stromal tumors) is a great example of that. But more common cancers are probably driven by two, or maybe three, mutated pathways or different disregulated pathways – kind of like HIV. We didn’t see people living with HIV for years, and, years, and years until we got to triple therapy. So the challenge for us now in cancer is how to identify the right molecular pathways and do the clinical trials and as quickly as possible move from using a single targeted drugs to giving triple therapies. 23andMe: We now have more than 800 people enrolled in our Sarcoma Community and are heading to 1,000. What is the significance of having that many people with Sarcoma in a research cohort?