Precision Medicine and Cancer
Precision Medicine and Cancer
Adrian Hunis MD *
Corresponding Author: Adrian Hunis MD, School of Medicine, Universidad de Buenos Aires (UBA), Emeritus Member of ASCO, Emeritus Member of ESMO.
Copy Right: © 2023 Adrian Hunis MD, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Date: April 28, 2023
Published Date: May 10, 2023
Precision Medicine and Cancer
Introduction
Precision medicine is a new approach to cancer treatment that involves using a patient's genetic information to create personalized treatment plans. By analyzing a patient's tumor at the molecular level, doctors can identify specific genetic mutations that are driving the cancer and target those mutations with drugs that are tailored to the patient's individual genetic profile.
Genetic mutations that are driving cancer are mutations or alterations in specific genes that result in the uncontrolled growth and spread of abnormal cells. These mutations can occur in different genes depending on the type of cancer, and can be inherited or acquired during a person's lifetime.
In some cases, genetic mutations that drive cancer may be present in a person's germline DNA, meaning they are inherited from one or both parents. Examples of inherited mutations that can increase the risk of cancer include mutations in the BRCA1 and BRCA2 genes, which are associated with an increased risk of breast, ovarian, and other cancers.
In other cases, genetic mutations that drive cancer may be acquired during a person's lifetime, often as a result of exposure to environmental factors such as tobacco smoke, radiation, or certain chemicals. These acquired mutations can occur in many different genes, depending on the type of cancer and the specific environmental exposures.
Identifying the specific genetic mutations that are driving a person's cancer is an important step in developing personalized treatments. This is because different mutations can have different effects on the behavior of cancer cells and their response to different treatments. By identifying the specific mutations that are driving a person's cancer, doctors can select treatments that are most likely to be effective and avoid treatments that are unlikely to be effective or may cause unnecessary side effects.
Precision medicine has shown promise in the treatment of cancer, as it allows doctors to more accurately predict which treatments will be most effective for individual patients. This can lead to better outcomes and fewer side effects, as patients are given treatments that are specifically designed to target their unique cancer cells.
There are several examples of precision medicine being used to treat cancer. For example, in some cases of lung cancer, patients with a specific genetic mutation known as EGFR can be treated with targeted drugs that block the activity of this mutation. Similarly, in some cases of breast cancer, patients with a genetic mutation known as HER2 can be treated with drugs that specifically target this mutation.
Overall, precision medicine has the potential to revolutionize cancer treatment by allowing doctors to create personalized treatment plans that are tailored to the unique genetic profile of each patient's cancer.
Precision medicine and agnostic therapeutics are not synonymous, although they share some similarities. (1)
Are precision medicine and agnostic therapeutics synonymous?
Precision medicine involves using a patient's genetic information to tailor treatment to their individual needs. This can involve identifying specific mutations or other biomarkers that are driving the patient's disease, and selecting treatments that target those specific molecular features. Precision medicine can be used in a wide range of diseases, not just cancer.
Agnostic therapeutics, on the other hand, refers specifically to a type of cancer treatment that is designed to target a common molecular feature across multiple types of cancer, regardless of the specific genetic mutations that are driving the disease. For example, some drugs are designed to target a particular protein that is overexpressed in many different types of cancer, such as PD-L1 or HER2. These drugs may be effective in a wide range of cancers, even if the specific genetic mutations driving the disease are different.
Agnostic tumors, also known as tumor-agnostic or histology-agnostic tumors, are a type of cancer that do not depend on the tissue of origin but rather on a specific genetic mutation or biomarker. Some examples of agnostic tumors include:
Microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) tumors: These tumors have mutations in the DNA repair pathway and are found in a variety of cancer types, including colorectal, endometrial, gastric, and pancreatic cancers.
NTRK fusion-positive tumors: These tumors have a fusion of the NTRK gene and are found in a variety of cancer types, including lung, thyroid, and gastrointestinal cancers.
BRAF V600E mutation-positive tumors: These tumors have a specific mutation in the BRAF gene and are found in several cancer types, including melanoma, non-small cell lung cancer, and colorectal cancer.
RET fusion-positive tumors: These tumors have a fusion of the RET gene and are found in several cancer types, including lung and thyroid cancers.
HER2-positive tumors: These tumors have an overexpression of the HER2 protein and are found in several cancer types, including breast, gastric, and lung cancers.
In summary, while both precision medicine and agnostic therapeutics involve using molecular information to guide treatment, precision medicine is focused on tailoring treatment to the individual patient's specific disease, while agnostic therapeutics are focused on targeting common molecular features that are shared across multiple types of cancer.
Precision medicine can potentially be used in any type of cancer, as it involves analyzing the genetic and molecular characteristics of a patient's tumor to guide treatment. However, the availability of precision medicine may vary depending on the specific type of cancer and the genetic tests that are available to identify mutations or other biomarkers that can be targeted with specific treatments.
Agnostic therapeutics are typically used in patients with advanced or metastatic cancers who have exhausted standard treatment options. These therapies are designed to target specific molecular features that are common across different types of cancer, regardless of the specific genetic mutations driving the disease. For example, some immunotherapies that target the PD-L1 protein have been approved for use in multiple types of cancer, including lung cancer, bladder cancer, and melanoma.
However, it's important to note that the use of agnostic therapeutics is still an emerging area of research, and their effectiveness may vary depending on the specific type of cancer and other factors such as the patient's overall health and other treatment history.
Yes, Pembrolizumab is an example of an agnostic therapy. It is a type of immunotherapy that targets the PD-1 protein, which is overexpressed in many different types of cancer. Pembrolizumab has been approved for use in several different types of cancer, including melanoma, lung cancer, head and neck cancer, and Hodgkin lymphoma, regardless of the specific genetic mutations driving the disease.(2)
Pembrolizumab is typical example of agnostic therapy
Pembrolizumab is considered an agnostic therapy because it targets a common molecular feature that is shared across different types of cancer. This is different from precision medicine, which involves using genetic testing to identify specific mutations or other biomarkers that are driving the patient's disease and selecting treatments that target those specific molecular features.
Pembrolizumab is a type of immunotherapy drug that belongs to a class of drugs known as immune checkpoint inhibitors. Its mechanism of action involves blocking the activity of a protein called programmed cell death protein 1 (PD-1), which is found on the surface of T cells (a type of immune cell).
PD-1 is an immune checkpoint protein that helps to regulate the immune response by preventing T cells from attacking healthy cells in the body. However, cancer cells can hijack this mechanism by expressing a protein called PD-L1, which binds to PD-1 on T cells and prevents them from attacking the cancer cells.
Pembrolizumab works by binding to PD-1 and blocking its interaction with PD-L1, which allows T cells to recognize and attack cancer cells. This can help to stimulate the immune system to attack and destroy cancer cells, which can lead to tumor shrinkage and improved outcomes for patients.
Pembrolizumab is approved for use in several types of cancer, including melanoma, non-small cell lung cancer, head and neck cancer, bladder cancer, and others. It is often used in combination with other treatments, such as chemotherapy or other immunotherapy drugs, to improve its effectiveness.
There are several other drugs that are currently used or being developed as agnostic therapies, targeting common molecular features across multiple types of cancer. Here are some examples:
Larotrectinib: This is a drug that targets the NTRK gene fusions, which are present in several different types of cancer, including lung cancer, thyroid cancer, and certain pediatric cancers.
Entrectinib: This is another drug that targets NTRK gene fusions, as well as the ROS1 and ALK gene fusions, which are present in certain types of lung cancer and other cancers.
Trastuzumab: This is a drug that targets the HER2 protein, which is overexpressed in certain types of breast cancer, as well as some cases of stomach and esophageal cancer.
Olaparib: This is a drug that targets the DNA repair pathway, which is disrupted in some types of cancer, including ovarian and breast cancer.
Vemurafenib: This is a drug that targets the BRAF mutation, which is present in certain types of melanoma and other cancers.
Overall, the development of agnostic therapies is an important area of research, as it allows for the development of treatments that can be used across multiple types of cancer, regardless of the specific genetic mutations driving the disease. (3)
Tamoxifen be considered the first personalized medicine
Tamoxifen can be considered one of the earliest examples of personalized medicine for breast cancer. Tamoxifen is a drug that has been used for several decades to treat breast cancer, and it works by blocking the activity of the estrogen receptor (ER), which is present in many breast cancers.
In the 1970s and 1980s, researchers discovered that not all breast cancers respond equally to tamoxifen treatment. Some breast cancers are ER-positive, meaning they have a high level of estrogen receptor expression, and these tumors are more likely to respond to tamoxifen treatment. In contrast, breast cancers that are ER-negative, meaning they have low or no estrogen receptor expression, are less likely to respond to tamoxifen.
This discovery led to the development of tests to determine the estrogen receptor status of a patient's breast cancer, which allowed doctors to identify patients who were most likely to benefit from tamoxifen treatment. This was one of the earliest examples of personalized medicine in breast cancer, as it involved tailoring treatment based on the specific molecular characteristics of the patient's tumor.
Since then, there have been many other examples of personalized medicine in breast cancer, including the use of targeted therapies such as trastuzumab for HER2-positive breast cancer, and the use of genomic tests such as Oncotype DX and MammaPrint to help guide treatment decisions.
The concept of personalized medicine has been around for several decades, and the use of personalized approaches to treat cancer, such as the use of tamoxifen for ER-positive breast cancer, has been around for more than 50 years.
In recent years, there has been a surge of interest in personalized medicine and the development of new technologies, such as genomic sequencing and targeted therapies, which are helping to advance the field. However, the basic idea of tailoring treatments to the specific characteristics of an individual patient's disease has been around for a long time.
Personalized medicine has revolutionized the way we think about diagnosing and treating diseases. By tailoring treatments to the specific characteristics of an individual patient's disease, we can achieve better outcomes, reduce side effects, and improve overall quality of life.
In the field of cancer, personalized medicine has led to the development of targeted therapies that are designed to target specific molecular features of a patient's tumor. These targeted therapies have shown promise in improving outcomes for patients with certain types of cancer.
Looking to the future, the field of personalized medicine is likely to continue to evolve and advance. New technologies such as genomic sequencing, liquid biopsies, and artificial intelligence are helping to improve our ability to identify biomarkers and develop more effective targeted therapies.
In addition, personalized medicine is likely to become more integrated into routine clinical care, as doctors and patients increasingly use genetic testing and other personalized approaches to inform treatment decisions.
Overall, the future of personalized medicine looks bright, and it has the potential to continue to transform the way we diagnose and treat diseases, leading to better outcomes and improved quality of life for patients. (4)
Conclusion
While personalized medicine and agnostic treatments have shown promising results in improving outcomes for cancer patients, it is important to note that cancer is a complex disease with many different factors that can contribute to its development and progression.
Personalized medicine and agnostic treatments allow doctors to tailor treatments to individual patients based on their unique genetic makeup and other factors, which can improve the effectiveness of treatments and reduce side effects. However, these treatments are not a cure for cancer on their own, but rather part of a larger strategy for managing and treating the disease.
Cancer research continues to advance rapidly, and new treatments and therapies are being developed all the time. While a cure for cancer has not yet been found, the hope is that personalized medicine and agnostic treatments, along with other advances in cancer research, will continue to improve outcomes for cancer. (5).
References
2. Proceedings ASCO 2022
3. Citation: Adrian Hunis MD, “Precision Medicine and Cancer” MAR Oncology Volume 5 Issue 5 www.medicalandresearch.com (pg. 7)
4. Journal of MAR Oncology (Volume 5 Issue 5)
5.(Https://siop-online.org/) Https://www.ehaweb.org/) Proceedings ASH 2022