Precision medicine is one of the many buzzwords in oncology as it is changing how oncologists view cancer treatment options – in an optimistic way. This positive outlook stems from the fact that precision medicine may help doctors select a treatment option that is more “precise” for each individual patient.
The History of Precision Medicine
The Human Genome Project, completed in 2003, marked a dramatic shift in the understanding of cancer and other diseases. After 13 years, researchers mapped the entire human genetic code, discovering that every human cell is packed with an estimated 20,000 to 30,000 genes. Researchers have used the discoveries to link dozens of diseases, such as Alzheimer’s disease and inherited colon cancer, to specific genes. In the case of cancer, researchers have discovered that two genes, BRCA1 and BRCA2, are associated with breast and ovarian cancers. Likewise, researchers have developed a drug specifically to treat breast cancers that demonstrate an overproduction of the protein HER2.
Such drugs, now standard in the treatment of breast, ovarian, lung and some other cancers, target inherited genetic abnormalities identified through genetic tests, which may detect mutations passed down from one generation to the next.
In recent years, the medical world has taken the advancements one step further, with genomic tests of the cancer itself. These even more targeted assessments study the DNA profile of the patient’s tumor, searching for genetic abnormalities that can be matched to a particular drug therapy that may not have otherwise been considered.
“This is an incredibly powerful, positive force in medical care. We were in the Dark Ages before this,” Dr. Maurie Markman, President of Medicine and Science at Cancer Treatment Centers of America® (CTCA), says of advanced genomic testing. “It is the tsunami on our shores, and it’s going to take over all of medicine. It is the future of cancer care, no question about it.”
7 Facts About Precision Medicine
Here’s what you need to know about this important innovation in oncology:
1. Personalized medicine has been around for a while but the term is fairly new.
In fact, personalized medicine has been used across many areas of medicine (not just oncology) for decades. General medicine has long used the concept of personalized medicine – identifying individual’s genetic traits – to treat patients. For example, when a person needs a blood transfusion, the patient’s blood is tested to identify their blood type and the blood type is matched to donated blood of the same type.
Precision medicine applies testing to analyze the cause of an individual patient’s disease at the molecular level through biological testing, such as advanced genomic testing, in hopes to identify a targeted treatment option. Today, precision medicine is most widely used in treating patients with cancer.
2. Genomic testing and genetic testing are not the same.
Genetic testing looks for specific changes or mutations in a person’s genes and can identify those that may be inherited. These mutations may increase a person’s risk of developing a disease, such as cancer. For cancer patients, genomic testing identifies the genetic abnormalities of an individual’s tumor that may dictate how their specific tumor behaves. When genomic testing finds abnormalities in a tumor, doctors may be able to tailor treatments to target those specific abnormalities. Genomic testing is one of the most widely used precision medicine diagnostic applications.
3. Genomic testing is now routine for some cancer types.
Although genomic testing is a rapidly developing area of medical science, testing is now considered standard of care for select cancers. Physicians often recommend that patients with these specific cancer types obtain genomic testing before determining treatment options. These cancers include some types of breast, colon and lung cancer as well as melanoma.
4. Genomic testing may provide a new option for patients.
People with other types of cancer, and who have not responded to standard-of-care treatments, may be referred for advanced genomic testing to search for genetic abnormalities that can be matched to a particular drug therapy that may not have otherwise been considered. Genomic testing may not be right for every cancer patient and an oncologist will help determine who is a good candidate.
5. Precision medicine may improve diagnosis and treatment, resulting in improved outcomes.
Precision medicine may help physicians more accurately diagnose cancer and select the most effective treatment(s) available. A landmark study showed that approximately one-quarter of patients who received treatment based on the specific genetic alterations of their tumor achieved a measurable degree of clinical benefit. Treatment based on the individual cancer’s molecular profile gave those patients a minimum 30 percent improvement in the time before their cancer began to spread compared to the previous treatment that the specific individuals had received. These results suggest that cancer patients who receive treatment based on precision medicine may experience improved survival outcomes.
6. Research and advancements will help expand precision medicine treatments for cancer and beyond.
With advancements in technology, genes can be identified more efficiently and effectively than ever before, allowing patients to potentially enroll in clinical trials like the Targeted Agent and Profiling Utilization Registry (TAPUR) study, which tests drugs that the FDA have concluded are safe and effective to treat specific mutations in specific cancer types. The TAPUR study aims to learn whether using these drugs in other cancer types with the same mutations will also yield safe and effective therapies. The advancements in technology also assist researchers in the discovery of new alterations as well as new treatments to target alterations, giving the medical community hope that the more wide spread use of precision medicine is on the horizon. Physicians hope to, one day, be able to use every conceivable type of information about a patient and their disease to develop a treatment plan tailored to each individual.
7. Precision medicine may soon be used to help personalize treatment for many other disease types to help advance outcomes.
For example, precision medicine for mental disorders could be transformative when considering which medications or psychosocial treatments are most effective for each individual. Complex diseases, such as heart disease, may have opportunity for precision medicine applications.
Due to what we now know about precision medicine, researchers have more defined targets for developing drugs and oncologists can potentially offer patients treatments that specifically target what drives the growth of their specific cancer. While there is still a tremendous amount to learn, precision medicine has changed the world of oncology for the better.