Oncologists take to precision medicine
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When Anant's colon cancer relapsed early this year and chemotherapy was recommended, he requested for treatment with the least side-effects. His doctor sent his blood sample for a specific chemotherapy he had in mind. The doctor is thanking his foresight after the test results showed that Anant severely lacked an enzyme needed to process or metabolize that particular chemotherapy drug. Had he been administered it, Anant may have had life-threatening side effects.
Such personalized or precision cancer care is about analysing a patient's tumour to determine what combination of drugs will work best. With this level of specificity also comes a greater potential to decrease toxic side effects, say experts.
"The study of analysing blood to test for genetic variants of enzymes that help process different types of drugs is called pharmacogenomics. Each individual processes a drug differently depending on his or her unique genetic make-up. What happened in Anant's case is one of the examples of precision medicine," medical oncologist Shona Nag said.
Precision cancer medicine is used to describe treatments which are given to patients with similar tumours, but tailored according to their unique genetic, physical and psycho social characteristics.
Two women, Arpita and Anjali, have the same stage and type of breast cancer and both required chemotherapy. "Arpita had severe diabetes and Anjali did not. The specialist chose different chemotherapies for each of them, making sure that Arpita did not suffer from side effects. Her treatment was personalized according to her special needs," said Nag.
Precision medicine is driven by newer diagnostic and therapeutic technologies and relies on the advances made by genetic sequencing of tumours and blood to precisely identify which treatment should be used and when.
"It helps choose the correct treatment for a particular tumour sub-type," Nag said. She heads the medical oncology department at Jehangir Hospital and is trustee of Nag Foundation that works in cancer care, research and education.
Software professional Rajat was recently diagnosed with advanced stage four lung cancer.
Ten years ago, despite undergoing chemotherapy sessions, he would not have survived for more than 6-8 months. Rajat was put through a biopsy and one of the lungs showed a type of cancer called adenocarcinoma. The tumour is subjected to genetic testing for abnormal `driver mutations'.
"These are genetic changes which actually drive the growth of the tumour," Nag said. Rajat was put on a new oral targeted therapy directed to stem this mutation. Since he responded well to treatment, it has significantly improved his chances of survival.
"Lung tumours can be sub-typed into distinct groups based on genetic profiles.There are specific non-chemotherapeutic drugs which treat these tumours. These are all examples of precision medicine," Nag said Precision medicine helps avoid unnecessary chemotherapy as well. Rashmi, a 43 year-old homemaker, was recently operated for breast cancer and the tumour which was removed, was a mild sub-type.
Her surgeon recommended that she see a medical oncologist for chemotherapy and when Rashmi explained her reservations to her oncologist, a genetic test called endopredict was done which characterized her tumour as low risk and she could safely avoid chemotherapy and take hormone tablets.
"Our treatment choices are now very precise with genetic tests on the tumour and especially in breast cancer it is now possible to avoid unnecessary treatments which may not benefit the patient at all," breast surgeon Anupama Mane said.
Success stories abound, but medical science has not achieved breakthroughs in treating many tumours.
Genetic sequencing and genetic profiling have identified many mutations in tumours. "Often, we don't know if these mutations are important enough to drive the tumour growth and spread. We can find the driver mutations, but there may not be effective drugs. So there are many caveats in precision medicine. It is the future of cancer care and it can change the way we treat cancer," Nag said.
Molecular geneticist Nikhil Phadke said, "We see patients with blood, breast, lung, and colon cancer being referred for genetic testing on a routine basis. This testing is either for predictive purposes or for precision medicine guidance, where genetic tests are increasingly being used to determine which drug may be used for treatment."
In some cases, more sophisticated genetic tests are required to ascertain why the patient is no longer responding well to the first choice drug, he added. "We have had more than a few cases where patients respond well after being put on a new drug based on the results of these tests," Phadke said.
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When Anant's colon cancer relapsed early this year and chemotherapy was recommended, he requested for treatment with the least side-effects. His doctor sent his blood sample for a specific chemotherapy he had in mind. The doctor is thanking his foresight after the test results showed that Anant severely lacked an enzyme needed to process or metabolize that particular chemotherapy drug. Had he been administered it, Anant may have had life-threatening side effects.
Such personalized or precision cancer care is about analysing a patient's tumour to determine what combination of drugs will work best. With this level of specificity also comes a greater potential to decrease toxic side effects, say experts.
"The study of analysing blood to test for genetic variants of enzymes that help process different types of drugs is called pharmacogenomics. Each individual processes a drug differently depending on his or her unique genetic make-up. What happened in Anant's case is one of the examples of precision medicine," medical oncologist Shona Nag said.
Precision cancer medicine is used to describe treatments which are given to patients with similar tumours, but tailored according to their unique genetic, physical and psycho social characteristics.
Two women, Arpita and Anjali, have the same stage and type of breast cancer and both required chemotherapy. "Arpita had severe diabetes and Anjali did not. The specialist chose different chemotherapies for each of them, making sure that Arpita did not suffer from side effects. Her treatment was personalized according to her special needs," said Nag.
Precision medicine is driven by newer diagnostic and therapeutic technologies and relies on the advances made by genetic sequencing of tumours and blood to precisely identify which treatment should be used and when.
"It helps choose the correct treatment for a particular tumour sub-type," Nag said. She heads the medical oncology department at Jehangir Hospital and is trustee of Nag Foundation that works in cancer care, research and education.
Software professional Rajat was recently diagnosed with advanced stage four lung cancer.
Ten years ago, despite undergoing chemotherapy sessions, he would not have survived for more than 6-8 months. Rajat was put through a biopsy and one of the lungs showed a type of cancer called adenocarcinoma. The tumour is subjected to genetic testing for abnormal `driver mutations'.
"These are genetic changes which actually drive the growth of the tumour," Nag said. Rajat was put on a new oral targeted therapy directed to stem this mutation. Since he responded well to treatment, it has significantly improved his chances of survival.
"Lung tumours can be sub-typed into distinct groups based on genetic profiles.There are specific non-chemotherapeutic drugs which treat these tumours. These are all examples of precision medicine," Nag said Precision medicine helps avoid unnecessary chemotherapy as well. Rashmi, a 43 year-old homemaker, was recently operated for breast cancer and the tumour which was removed, was a mild sub-type.
Her surgeon recommended that she see a medical oncologist for chemotherapy and when Rashmi explained her reservations to her oncologist, a genetic test called endopredict was done which characterized her tumour as low risk and she could safely avoid chemotherapy and take hormone tablets.
"Our treatment choices are now very precise with genetic tests on the tumour and especially in breast cancer it is now possible to avoid unnecessary treatments which may not benefit the patient at all," breast surgeon Anupama Mane said.
Success stories abound, but medical science has not achieved breakthroughs in treating many tumours.
Genetic sequencing and genetic profiling have identified many mutations in tumours. "Often, we don't know if these mutations are important enough to drive the tumour growth and spread. We can find the driver mutations, but there may not be effective drugs. So there are many caveats in precision medicine. It is the future of cancer care and it can change the way we treat cancer," Nag said.
Molecular geneticist Nikhil Phadke said, "We see patients with blood, breast, lung, and colon cancer being referred for genetic testing on a routine basis. This testing is either for predictive purposes or for precision medicine guidance, where genetic tests are increasingly being used to determine which drug may be used for treatment."
In some cases, more sophisticated genetic tests are required to ascertain why the patient is no longer responding well to the first choice drug, he added. "We have had more than a few cases where patients respond well after being put on a new drug based on the results of these tests," Phadke said.
Labels: blood tests, chemotherapy, endopredict, enzymes, genetic tests, precision medicine, unnecessary treatments
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