Personalised treatments fight cancer molecule by molecule
“Way back, ages ago, we thought that cancer is defined as cells that grow fast,” Dr Dani Edmunds, from Cancer Research UK, explained. Treatments were, and still are, based on this premise, targeting and destroying fastgrowing cells through chemotherapy and radiotherapy, killing any cancer.
“As we know more, we know that different cancers are … different,” he added. “Now we’re thinking, ‘What if we don’t look at the cancer based on its location but based on its genetic makeup?’ Because of the rise in DNA sequencing it’s so much easier to sequence or read the DNA of cells in our tumours.”
This new era of hyper-personalised, genetically informed cancer care is already changing for ever the way the disease is treated.
Professor Peter Johnson, the National Clinical Director for cancer at NHS England, said: “We’ve seen a transformation of our understanding of the biology and the drivers of cancer for ten to twenty years now.”
While the location of a cancer is still relevant, a far more detailed understanding of the disease is now required.
“We simply don’t talk about breast cancer any more,” Johnson said. “We talk about several different molecular types of breast cancer.
“That matters because what we’ve found in trials is that the way you need to treat them is different.”
This personalised approach is changing care from diagnosis and treatment, to preventing the return of cancers. In terms of treatment, some patients can now access immunotherapy, in which a person’s immune system is trained to destroy cancerous cells.
New techniques are also emerging for cancers with different genetic profiles, allowing doctors to hyper-personalise treatments to each individual case.
“It could be that we find a change, a fault in a gene that causes lots of breast cancers,” Edmunds said. “And then scientists go and develop a drug that targets and blocks that fault to treat breast cancer.”
In a study published today in the journal eBioMedicine, scientists have done just that — creating a test for breast cancer that predicts the likelihood of it returning within two weeks of the treatment being started.
Scientists from the Institute of Cancer Research, London, were able to detect the likelihood of a cancer recurrence in patients with oestrogen receptor-positive, human epidermal growth factor receptor 2-positive breast cancer.
This meant that some patients could “de-escalate” their treatment sooner, while others could get more intensive interventions earlier.
Patients are already finding that this more personalised approach is increasing the chances of survival, giving them a better quality of life and a greater peace of mind.
Annie Baker, 45, was diagnosed with breast cancer during the pandemic in 2021.
After initial brutal treatment of chemotherapy and a mastectomy, she learnt that she had the BRCA2 gene, making the chances of her cancer returning far more likely.
Instead of living under the shadow of a returning cancer, Baker, who works in waste management, enrolled in a trial designed specially for people with this mutation.
In the trial by researchers at the London cancer institute, Baker was prescribed Olaparib tablets twice a day for a year. In doing so, she cut by more than a third her chances of the cancer returning.
By simply taking this drug she avoided the threat of another debilitating course of chemotherapy.
During her treatment, Baker was well enough to complete a 10km race and continued working — which she said was “amazing” for her peace of mind.
“I was a mum at home,” she added. “I was just able to live my normal life. I felt a bit queasy to begin with and I was definitely a bit more tired and things.
“But it was two tablets twice a day for a year and it’s been just an amazing change in prognosis really. I felt much more positive. I just had more hope and more reassurance.”
Innovations in testing within NHS England have improved patients’ care.
Johnson said the liquid biopsies allowed for an early diagnosis and a faster look at the genetic profile of any potential cancer.
“It’s interesting because it tells you not just that there might be a cancer present in the body but gives you a very strong indication as to whereabouts in the body it would be,” the professor added. “This is obviously important for the NHS because we need to know how to investigate people.
“We need to know whether to do a CT scan of their chest or a colonoscopy to look at the lining of their bowel, for example.”
Johnson said specialised care would not eradicate all the side effects of treatment but it would ensure that all the treatments were right for each patient.
“It will allow us to diagnose cancers at an earlier stage,” he added. “It will help us to work out what the most effective treatment is to maximise people’s chances of surviving cancer.
“It will help us to use the resources of the NHS as efficiently as possible to make sure that we’re getting the best possible results of treatment for the investment that we make and it will help people to have the treatment which is right for their type of cancer.
“[Cancer is] an ever-growing problem and we need to make sure that we are doing everything we can to maximise the chances of survival. The NHS isn’t just a passive recipient of this developing knowledge.
“We need to make sure we’re a really active partner in helping people to get the research done, helping to find patients who might be suitable for [upcoming] trials.”
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