Treatment Personalized to Your Cancer's Biology
Precision Medicine at John Theurer Cancer Center
Precision medicine (also called “personalized medicine”) has changed the way doctors care for people with cancer. Knowing the genetic changes that drive the growth of tumors can help scientists understand how a cancer grow and spreads, enabling them to design new treatments that work by zeroing in on those changes. At John Theurer Cancer Center at Hackensack University Medical Center, we take a precision medicine approach to the treatment of cancer, matching patients with anticancer therapies that target the abnormalities fueling their disease. Precision medicine forms the foundation of our Translational Medicine Program.
Why Is Precision Medicine Important?
Two patients with the same type of tumor that looks the same under the microscope may in fact have diseases that behave very differently. People with cancer have traditionally received the same treatment as others with the same type and stage of cancer. Yet some people responded well to their therapy and others did not, indicating there were other factors at play that influenced the growth of their cancers.
That’s where precision medicine comes in. Thanks to advances in science and technology, the pace of research in precision medicine has accelerated, leading to new discoveries and more therapies that target some of these specific genetic changes and other molecular abnormalities that promote the growth of cancer cells. We can now analyze each patient’s tumor to pinpoint the molecular changes driving that cancer’s growth. With this information in hand, our doctors can:
• Confirm a diagnosis
• Learn about a tumor’s behavior, such as whether it is slow-growing or aggressive
• Use this information to match a patient with a drug that may target that abnormality or other therapies (such as chemotherapy, immunotherapy, radiation therapy, and/or surgery) known to be effective against that cancer
• Avoid treatments that may not work against a tumor, sparing patients from their potential side effects while reducing the cost of cancer care by bypassing the use of ineffective therapies
How Your Cancer Is Analyzed
To determine which genetic changes may exist in your cancer, we analyze a tissue sample (biopsy). Blood samples may also be analyzed to find genetic changes in leukemia or other blood diseases. The samples are sent to a special lab where a machine called a DNA sequencer looks for genetic changes related to the cancer. This is also called genomics testing, molecular profiling, or even tumor profiling. It gives us the information we need to choose the best treatment for you.
Precision Medicine and Clinical Trials
Clinical researchers at John Theurer Cancer Center and elsewhere may use precision medicine approaches to select the patients most likely to benefit from a new treatment being assessed in a clinical trial. For example, if a new drug targets a specific protein on the surface of cancer cells, patients may need to have that protein on their tumor cells in order to enroll in the study. Precision medicine can therefore expedite cancer research by eliminating patients who are not likely to benefit from an investigational drug, yielding study results that support the drug’s effectiveness select patients and clarifying the medication’s most appropriate indication. It could even lead to faster drug approvals.
Examples of Precision Medicine in Practice
Precision medicine has led to the approval by the U.S. Food and Drug Administration (FDA) of many anticancer treatments indicated for cancers with specific genetic and molecular changes. Here are just a few examples:
- Trastuzumab (Herceptin®) for patients with breast cancer that produces high levels of a protein called HER2
- Imatinib (Gleevec®) for patients with chronic myelogenous leukemia (CML) that contains a genetic abnormality called the “Philadelphia chromosome”
- Crizotinib (Xalkori®) for patients with non-small cell lung cancer that contains a mutation in the ROS or ALK genes
- Dabrafenib (Tafinlar®) and trametinib (Mekinist®) for patients with melanoma containing a specific mutation in the BRAF gene
The Future of Precision Medicine
With today’s genomics profiling happening faster, more efficiently, and less expensively, investigators are identifying new cancer-related genetic changes more quickly than ever before. Their findings continue to lead to the development of novel therapies, more clinical trials assessing those treatments, and new cancer drugs approved by the FDA for use in patients.
In addition, all cancers early on shed some of their genetic materials, vesicles or even cancer cells in the bloodstream. These can be accessed easily in the peripheral blood and are now referred to as liquid biopsies. These liquid biopsy approaches include the analysis of circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and tumor-derived extracellular vesicles like exosomes. At John Theurer Cancer Center, we already perform these liquid biopsies to help refine our patients’ treatment options. The major advantage of liquid biopsy analysis is that it is minimally invasive, and can be serially repeated, to help guide therapies and monitor patients’ response in real time. “This is a new area of cancer care, with rapidly rising impact and I am proud we can offer this technology to our patients at John Theurer Cancer Center” says Andre Goy. MD. Chair of John Theurer Cancer Center.