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Cancer treatment gets shot in arm with next gen sequencing: Dr Akhil Chopra

Laxmi Yadav, Mumbai
Saturday, November 11, 2017, 08:00 Hrs  [IST]

Cancer genomic sequencing identifies mutation in genes, and this paves the way for development of targeted therapies for specific cancer types, that could be as varied as the people who have them. The development of personalised health care (PHC) has made it possible for providing doctors with options to select the right treatment for patients to improve outcomes, says Dr. Akhil Chopra, specialist, medical oncology at OncoCare, Singapore.

“Targeted therapy or precision medicine is an emerging approach of cancer treatment which is designed to attack mutation responsible for cancer cell with minimal side effects,” he says. It has done wonders in treating certain types of breast cancer, lung cancer, melanomas, etc. In particular, genetic testing has proven effective in lung cancer, impacting therapeutic outcomes for patients tremendously.

There are primarily nine mutations identified for lung cancer – EGFR, KRAS, MET, LKB1, BRAF, PIK3CA, ALK, RET, and ROS1. EGFR causes one-fourth of lung cancer cases, which can be identified with genetic testing, and permitting targeted therapy. According to Dr. Chopra, the patients who get targeted drugs respond positively and live longer.

Next gen sequencing of cancer cells also helped identify newer mutations responsible for incidence of the disease. “This paved the way for development of newer drugs and even more targeted therapies,” Dr. Chopra adds. Tests like those provided by Foundation One are designed to provide physicians with clinically actionable information to guide treatment decisions for patients based on the genomic profile of their disease. The test results provide information about clinically significant alterations, potential targeted therapies, available clinical trials, and quantitative markers of response for immunotherapy.”

Despite these advantages, genetic testing faces some challenges. It’s not appropriate for every cancer patient. Even if genetic mapping of cancer cells is done, medication for every mutation may not always be available. “Doctors have to be judicious and selective in deciding which patients should go in for genetic mapping,” he opines.

Another name for PHC is precision medicine. It has – with genomic mapping –emerged as a new hope for cancer patients whose health or mortality has not improved with existing therapies. However, it has some way to go to before it makes a significant impact on cancer treatment; precision medicine has a few limitations.

Currently, it targets a single mutation. Usually, it takes multiple mutations over a lifetime to cause cancer. There are cases where multiple cancer cells are found at one spot. Under these circumstances, one drug is not useful. But combined therapy that targets two mutations can achieve desired outcomes in the future.

“In solid cancers like some types of lung cancer, colon cancer, and breast cancer that comprise of many mutations, targeted therapy with a single drug may not be as effective,” Dr Chopra adds. “Even if one detects the mutation, curative drugs can be highly inaccessible.”

Besides precision drugs, immunotherapy has emerged as another potential treatment option for cancer over the last few years. Biologic drugs have proved to be the catalyst for treating certain types of cancer like blood cancer or leukemia. “Recently there have been reports indicating that the total mutational burden of a cancer can help predict its response to immunotherapy,” Dr. Chopra concludes. For people suffering from a disease with the highest mortality rate in India, that is good news.

 

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Colin Aspin Nov 12, 2017 12:11 PM
I disagree, genetic testing is appropriate for everybody and should be made available to someone diagnosed with cancer knows what mutation is present and thence the treatment options available.
 
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