Thursday, October 28

My cancer, my treatment: why each tumor needs its own therapy | Society

Fran was 39 when she was diagnosed with lung cancer. It was 2012, and none of the tests available at that time managed to identify any mutation in her tumor. “It was lung cancer, no more. I started chemotherapy and spent three years with ups and downs: the tumor shrunk, then progressed… I tried other treatments and entered clinical trials, but it couldn’t be prevented from having metastasis ”. And one day, just before undergoing radiation therapy to the head to enter a new clinical trial, the researchers found the mutation and were able to name the tumor: “My cancer was a ‘ROS1’. From there, a great advance: I was able to access personalized therapy, which even allowed the disappearance of brain metastases ”.

María José was also diagnosed with cancer. In her case, of the breast, and with the aggravating circumstance that at that time she was 34 weeks pregnant, which is why, to start treatment, she had to be given birth. “My tumor was triple negative. When I read on the Internet that it was the only breast cancer for which there was no cure, I said to myself, ‘Oh my God, I’m dying.’ My oncologist at Ramón y Cajal reassured me. They did new tests on me, it was found that it was an infiltrating ductal carcinoma –not encapsulated, as they had told me in the first center where they did the biopsy– and they opted for chemo ”. María José agreed to enter a study in which they put a tumor marker before each chemotherapy to see the evolution. And the results were positive: “The treatment was ‘eating’ the tumor. So much so that I didn’t even have to go through surgery: I have no metastases, no nodes, nothing. It is a complete answer ”.

The cases of Fran and María José show, on World Cancer Day, how advances in research are allowing to change the way of understanding this disease. Rather, to understand the more than 200 diseases that make up what we generically call ‘cancer’.

Personalized treatments

A good part of this progress has its origin in a deeper understanding of the molecular characteristics of tumors, which has allowed the development of personalized precision medicine. “It is a matter of deepening our knowledge of genetic alterations in tumors and, from there, developing specific therapies,” explains Dr. Luis Paz-Ares, head of the Medical Oncology service at the Hospital 12 de Octubre in Madrid. We no longer only diagnose a tumor morphologically: we also give it the surnames ”.

Precision treatments increase the response rate. And if the cancer progresses or recurs, we are able to identify why and offer the patient a second or third personalized treatment

Luis Paz-Ares, head of the Medical Oncology service at the Hospital 12 de Octubre in Madrid

Those last names are, precisely, molecular alterations. Thus, for example, identifying that Fran’s cancer had the mutation in the ROS1 gene made it possible to provide her with a personalized, precise treatment, targeting that mutation. “Precision treatments increase the response rate,” continues Dr. Paz-Ares. And, furthermore, it is not exclusive to the initial diagnosis: if the cancer progresses or recurs, we are able to identify why with new analyzes, and we can offer the patient a second or even third personalized treatment adjusted to the type of mutation that may appear. in every moment”.

In this change of model, the key concept is’personalized medicine‘. Until not long ago, oncologists did not know why the same treatment produced so many different responses in patients who had – at least apparently – the same type of tumor. While some responded favorably and without sequelae, others suffered significant adverse effects and the others, directly, did not experience improvement. “The dream was to have different alternatives and to know, in each case, which treatment would be more effective and with fewer side effects in each patient. Now, thanks to the identification of the mutations, we have achieved treatments aimed at this differential fact ”.

Even though it may seem new to us, the path began many years ago. It began, says Dr. Lucía González-Cortijo, head of the Medical Oncology service at the Quirónsalud Hospital in Pozuelo and an expert in breast and gynecological cancer, with tamoxifen. “This drug was the first targeted therapy in hormone-dependent breast cancer. That at the end of the 60s and, since then, we have evolved a lot. We have been identifying different subtypes of breast cancer and obtaining more sophisticated treatments for each of them ”. With regard to triple negative cases, he notes, “a great effort is being made in research to find better treatments and reduce toxicity. Personalizing therapies is essential, because not all triple negative tumors are so aggressive. We could define it as ‘not killing flies with cannon shots’ ”.

The advancement of immunotherapy

Dr. Gilberto Lopes, professor of Medical Oncology at the University of Miami and director of Oncology at the Sylvester Comprehensive Cancer Center, agrees with her: “It has totally changed the way we work and see patients. Now, for most solid tumors we have molecular tests that allow us to see their specific characteristics and help us to define the treatment that is best likely. But, in addition, we must highlight a last achievement, immunotherapy, which is allowing us to provide solutions to tumors for which there were hardly any options before ”.

This technique is representing a great advance in oncology. “For decades, the options for most cancer patients consisted of chemotherapy, radiation therapy and surgery,” recalls Federico Plaza, Roche’s director of Corporate Affairs. Afterwards, personalized precision medicine, made possible by understanding the molecular basis of different cancers, was a leap; now the next step comes from the hand of the immunotherapy, with the development of antibodies that help the immune system to detect and defend itself against tumor cells ”.

Among the advantages of this new treatment, Plaza highlights its versatility. “It is very versatile, it is not aimed at a specific therapeutic target of a type of tumor, but in the context of the immune system. Immunotherapy represents a great evolution in certain tumors for which we only had the option of chemotherapy ”.

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