Personalized cancer treatment – transfer to individual therapy protocol
Cancer developing is connected in most cases with a mutation of a human genome.
Nowadays, our oncologists use new methods for definition of cancer genomes-oncomarkers (DNA mutations). This allows not only to identify precisely cancer tumor type but also the impact of different drugs on it that are not included in the standard anticancer therapy. So, patient and doctor are informed what exactly will work on a specific tumor of a specific person.
Onсo-tests are genomic and genetic studies for detection of DNA mutations with using biopsy of tumor tissue or blood tests which help to choose correctly the precised treatment of cancer tumor for each patient out of standard treatment.
Personalized or precision cancer treatment in Israel:
Each person inherits a set of genes from both parents. This gene which is available in almost all cells of the body and embodied in the structure of DNA strands. If in the cellular DNA occurs a defect or mutation that may lead to inclusion of cancer genes, the body cannot control this process. The defective cell continues to multiply that results in the appearance of the cancer. Mutations can occur as a result of exposure to endogenous and exogenous causes (for example cancerogenic chemicals, radioactiveradiation, etc.). And only а very small number of cases the mutation is inherited from parents. In many cases, the cause of the mutation remains unknown.
What is the importance of identifying changes in the DNA of the cancer cells.
Detection of DNA mutations in cancer cells and the definition of genes-markers allows to develop the personalized treatment. That is the individual therapy protocol in accordance with a genetic profile of the cancer tumor. Individual therapy has an advantage in selection of the most effective type of treatment, in comparison with standard protocols previously passed by all the patients depending on the primary tumor: chemotherapy, radiotherapy and surgery.
Personalized treatment is the targeted and highly effective drug treatment, accompanied by fewer side effects. Treatment includes special anticancer drugs and cures directed against the mutating cancer cells. Such therapy has much less effect on healthy cells.
In many cases, due to early diagnosis the tumor can be removed by surgery. In some cases, such as colon cancer, breast cancer or prostate cancer, the question often arises whether a prophylactic treatment, radiotheraphy or chemotherapy is necessary. In such cases, doctor may recommend genetic tests for genes-oncomarkers in the colon, breast and prostate.
In order to prepare the patient for the narrowly targeted and personalized treatment against a certain type of cancer and diagnosis of tumor mutations, as well as for definition whether a patient-focused and personalized treatment approaches, three types of researches are applied:
⇒ The study of tissue samples (Tissue Panels) – after sampling tissue biopsies is used method of sequencing genes-oncomarkers.
⇒The study of sample liquid (Liquid Panels) – after sampling blood issued method of sequencing genes-oncomarkers.
⇒ Inclusive genome-proteomic studies (Ultra-Coverage Genomic Proteomic). General genome sequencing of tumor cells distant tissues.
Differences between chemotherapy, immunotherapy and biological treatment
Nowadays, it is very easy to get lost among the millions of web pages and social networks about cancer treatment (chemotherapy, biological or targeted therapy, immunotherapy (immunological treatment). Before starting treatment it is very important to know the basic concepts, and also to learn how to compare different types of treatment, depending on the type of disease.
Precision treatment of ovarian cancer
Precision (personalized) treatment of ovarian cancer – is the target method that helps to prevent ineffective “trial and error” way, loss of valuable time and to avoid undesirable side effects.
Caris – Molecular test
Caris Molecular Intelligence is an analysis of a cancerous tumor at the molecular level that helps to make the most detailed profile of the malignant tissue, on the basis of which our oncologists can recommend to the patient drugs actually effective on his tumor, and also to determine the list of drugs that will not be effective.
Personalized lung cancer treatment
Lung cancer can origin from different types of lung cells and even within the same cell type, caused by various molecular anomalies. In the personalized treatment of a patient, taking into account his individual circumstances, the first step is to identify the cells of the cancer origin. In 10-15% of cases, lung cancer belongs to the subtype of “small cells”. The majority of people, however, suffer from non-small cell lung cancer (NSCLC). This type of lung cancer is classified as squamous cell carcinoma or adenocarcinoma.
In some of these cancer cell subtypes are identified specific molecular targets. It is very important to understand which mutations are the main factor causing uncontrolled tumor growth in a certain patient. If the identified genetic abnormality is the target of a particular medicine, then one can hope for a useful therapeutic effect. Patients should be aware of the difference between lung cancers. An accurate diagnosis can be made by examining tissue taken from a tumor using lung biopsy.
In the treatment of all cancers, the risk of excessive treatment that causes side effects, not benefiting the patient, should be balanced with the risk of underestimation of the disease, leading to ineffective treatment, a decrease in the quality of life and the chance of survival. Over the years, the benefits of chemotherapy for advanced lung cancer have been relatively small. And the toxicity associated with treatment was significant.
During last years the increased ability to understand the molecular mechanisms responsible for the development and progression of NSCLC in specific patient groups has caused need in targeted drug therapy that is more effective and better tolerated by patients. For recommendation of a personalized treatment, our doctors examine the lung cancer tissue for two molecular anomalies:
1. Epidermal growth factor receptor mutations (EGFR);
2. Rearrangement of the gene for anaplastic lymphoma kinase (ALK).
These anomalies confirmed as biomarkers, which predict a good response to specific classes of drugs.
In about 10% of patients with NSCLC, epidermal growth factor receptors are abnormally sensitive, and cell division goes out of control. Cancer with this pathology responds well to a class of oral medications called EGFR tyrosine kinase inhibitors. They block the transmission of growth signals from the activated receptor to the nucleus of the cell. Patients with lung cancer who do not have sensitizing EGFR mutations will react to these agents to a minimal extent.
About 5% of patients with NSCLC have tumors that exhibit anomalies in the ALK gene, which results in an overactive form of the enzyme that stimulates growth. Cancer, which is ALK-positive, responds well to treatment with tyrosine kinase inhibitor that blocks the transmission of growth signals to the cell nucleus.
Asian origin are more likely to have the EGFR mutations. Cancerous lung tumors in women and non-smokers have more chance of developing cancer that promotes ALK mutation. In both cases, the diagnosis of these anomalies requires sophisticated technology and should only be carried out in specialized laboratories in Israel with rigorous procedures to ensure quality control.
In most patients with NSCLC whose tumors do not express EGFR or ALK anomalies, the search will continue using biomarkers that characterize their specific disease and drugs that can be used to treat them.
But care for lung cancer patients can be personalized in many other ways, even when abnormalities were not identified that lead to specific drugs. In this case very important is accurate assessment of the size and location of the primary tumor and the extent of the disease, which may be performed by complex imaging techniques, such as positron emission tomography (PET) and magnetic resonance imaging (MRI). They play an important role in the accurate detection of secondary malignant tumors (metastases) as well.
Tumors of small lung sizes can be treated surgically, often with additional radiation therapy. A disease that has spread locally or to other parts of the body may require systemic treatment. Typically, this is based on chemotherapy drugs containing platinum.
Chemotherapy can be combined with a biological agent, that targets the vascular endothelial growth factor (VEGF). This factor promotes the growth of blood vessels, including those that supply blood to the tumor. Preventing this can lead to a reduction in the tumor.
Because lung cancer is so closely associated with smoking, which has many negative health effects, these patients are often associated with respiratory, cardiac and vascular diseases. Perhaps they are already limited in their activities. These factors may mean that cytotoxic chemotherapy with combination of drugs is not appropriate. An alternative to the use of a single cytotoxic agent is possible. When choosing cancer treatment in personalized medicine, such problems are taken into account by our Israeli oncologists and with the patient’s preferences.
Although 80-90% of cases of lung cancer are caused by smoking, some of them occur in people who have never smoked and are more likely to be found in women than men.
Although targeted biological agents and chemotherapy can stop the growth of many lung cancers within a few weeks or months, or even reduce their size, most tumors eventually resume growth. In this case, effective second-line procedures are needed.
Some patients, at present, are successfully treated by a new class of targeted antibodies, called checkpoint inhibitors. A characteristic feature of many types of cancer is that they find ways to resist the immune response of body. A new class of inhibitors of control points has been described as the removal of brakes from the immune system, which gives him more opportunities to fight cancer.
The first such agent for lung cancer was nivolumab, followed by pembolizumab (Keytruda).
Thus, testing this biomarker and many other procedures mentioned above, is another example of the importance of personalized medicine, which determines the most appropriate treatment, taking into account the specific molecular characteristics of the cancer that affect the certain patient.
Personalized treatment is widely used by our Israeli oncologists in the treatment of lung tumors and proves its effectiveness.
Personalized colon cancer treatment
Colorectal cancer is one of the most common malignant diseases in the world. To date, despite the fact that at the time of detection, about 25% of patients have been diagnosed with multiple spread to other organs (metastases), the survival of 60% of these patients has increased up to 5 years. The range of drugs available for the treatment of metastatic colorectal cancer is rapidly expanding. In addition, great progress has been made in this field and in others, which led to the possibility of individual treatment for different groups of patients.
Significant benefit also is from diagnosing at an early stage, when the most probable and still possible is surgical intervention, as well as from new methods capable of destroying some tumor metastases. An important contribution made also with more precise detection of pathological zones throughout the body by improving the visual diagnosis – PET-CT.
Variety of successes achieved and their numerous effects on the individual patients treatment allow to get recommendations for the initial treatment of metastatic colon cancer, as well as options available for second and third line treatment that may be required if the tumor does not respond to first-line drugs or if it grows again after the treatment.
All these treatment decisions are made taking into account the specific characteristics of each patient.
Colon cancer therapies mechanism
⇒ Abnormal growth signaling and biological therapy
⇒ Molecular testing and targeted therapy
⇒ Abnormal mechanisms of cell renewal and immunotherapy
⇒ Treatment of patients with minor metastases
The best and most personalized treatment now depends on the control by highly qualified oncologists, the leaders of cancer centers, with many years experience.
For treatment of each individual patient, we combine a team of experts from different fields – medical oncology, pathology, surgeons, radiation therapy, visual diagnostics, who cooperate to determine the most effective individual therapies at each stage of the disease.
Our doctors can choose personalized treatment for the patient on the basis of molecular oncotests, as a result of which the tumor’s genetic profile is compiled.
In addition to general molecular tests, in Israel there are tests for precision treatment of colon cancer:
♦ Oncotest CTS – Immunoscore Colon
♦ Oncotest OncotypeDX Colon Cancer
These tests are performed for patients with locally advanced stage II or III colon cancer, and are also used by our doctors to assess the risk of relapse after surgery and the need for additional treatment.
Personalized breast cancer treatment
The probability of full breast cancer recovery in recent decades has increased significantly, due to the introduction of new scientific developments and research.
Today, in addition to surgery, radiotherapy and systemic treatment according to standard protocols in Israel most of patients receive personalized treatment that really increases the chances of survival and a positive prognosis for each individual patient.
The main problems of standard management are the excessive treatment and the absence of an individual therapy protocol. To prevent over-treatment, it became necessary to classify patients, that allows to determine a positive prognosis for them accordingly and to cancel or reduce adjuvant therapy as well. Another factor that strongly affects the patient is the use of endocrine therapy for many years.
Studies show that lifestyle changes affect the effectiveness of drugs and itself helps to improve the prognosis. Therefore, it is important to focus not only on treatment of a cancerous tumor, but on the patient as a whole.
Each tumor has many different subtypes.
Due to the molecular medicine achievements and special tests for oncomarker genes, it is possible to determine the type of tumor. Medical care for women with breast cancer is improved by adapting treatment to the molecular characteristics of individual tumors, through personalized treatment, and taking into account the size and location of the tumor, the hormonal status of the patient during menopause.
Personalization begins with screening or preventive screening.
The number of breast cancer cases is growing because of an earlier detection with the help of mammography and general aging of the population, due to this fact cancer is now being cured, and the personalized treatment makes a huge step in this direction.
This approach starts with screening. Women from families with known cases of breast cancer are at a higher risk of developing this disease. This is especially important if the woman is a carrier of BRCA1 or BRCA2 genes mutation. It means that cells do not effectively repair their own DNA. Women with a family history of breast cancer (and ovaries) can be diagnosed for a mutation of the BRCA marker gene and need more frequent screening. The use of magnetic resonance imaging (MRI) and positron emission computed tomography (PET-CT) expands the possibilities in detecting tumors at an early stage.
Currently, anti-cancer treatment continues to depend on the evaluation of critical targets in the tumor – hormonal receptors and HER2 overexpression, and since tests for their identification are very sensitive, it is important that samples of tumor tissue be evaluated in a laboratory that corresponds to strict quality criteria.
Such a study to determine a personalized protocol of treatment can be done in Israel under the guidance of well-known oncologists.
Science is developing rapidly: patients are invited to participate in clinical trials where a comprehensive molecular tumor profile is compiled and patients are given access to drugs that accurately affect certain types of cancer cells.
Determination of protocol for the breast cancer treatment.
Nature of treatment should be determined taking into account specific conditions such as type of malignant cells, the size of the tumor and its variety (differentiation degree between cancer and normal cells when viewed under a microscope). One more important thing here is to determine with the help of PET-CT, whether the cancer has spread only to the breast or has passed to the lymph nodes in the armpit, knots and organs in another place of the body. The spread of cancer cells to body organs distant from the primary tumor is called metastasis.
The initial treatment of most women with breast cancer diagnosed at an early stage begins with surgery. With lumpectomy it is possible to maintain a healthy breast tissue, while removing the tumor and the surrounding tissues, in contrast to the mastectomy, when the thoracic gland with the adjacent lymph nodes is completely removed.
In the case of inoperable tumors, chemotherapy is sometimes prescribed.
The current or potential spread of cancer within the breast or in the surrounding area can be restrained by radiation therapy. But systemic cytotoxic chemotherapy is often required if there are metastases in another part of the body. This therapy rapidly kills dividing cells. The disadvantage of this therapy is that quickly divide cells may be both cancerous and healthy, for example, rapid division of cells in the bone marrow and gastrointestinal tract is a part of a normal physiological process. But the chemotherapy do not differ this cells. Side effects of this therapy is increased risk of concomitant infectious diseases, as well as nausea and vomiting.
Personalized protocol based on special molecular genomic tests allows woman to avoid not necessary toxic drugs that do not affect the tumor.
Treatment based on the molecular characteristics of breast cancer.
When making a decision about treatment, oncologists increasingly take into account the molecular characteristics of the tumor of an individual patient. In order for a personalized therapy to match the patient, it is necessary to determine the biological factors that lead to tumor growth in specific cases.
Due to respond of the breast tissue to hormonal changes in the woman’s body, many cancers have estrogen receptor expression and growth in response to their activation. Many years ago doctors determined that the growth of female breast tumors that are positive for the estrogen receptor (ER +) can be prevented or delayed by anti-estrogen drugs tamoxifen and aromatase inhibitors. These were the first targeted drugs for breast cancer. Now, the tumor profile test allows to check action of different drugs on the tumor (chemotherapy, immunotherapy and biological drugs). So, our doctors get a wider range of drugs and their combinations that may have effect for a specific patient but were not considered before according to the standard treatment.
Personalized treatment is widely used by our Israeli oncologists in the treatment of female breast tumors and proves effective with every successful case of curing cancer.
Molecular oncotests help our doctors choose the personalized treatment for the patient, as a result of which the tumor’s genetic profile is compiled.
In addition to general molecular tests, Israel also conducts tests for personalized treatment of breast cancer:
♦ Oncotest EndoPredict
♦ Oncotest OncotypeDX
What is personalized cancer treatment
A new approach to cancer treatment is a personalized protocol, tailored individually for each patient.
Dr. Raanan Berger – Director of Oncology Institute, Chaim Shiba Medical Center, Tel ha Shomer, Israel.
Personalized treatment is a new approach that supposed to be a future for cancer management.
Why personalized treatment is important?
Two women with breast cancer and metastases in the lungs come in oncology department. Both women have tumor of 2 cm in the breast and 4 lung metastases, the same pathology response, both patients receive the same treatment protocol. One patient responds well to treatment – the tumors disappear, but the woman suffers very much from the toxicity of therapy – nausea, vomiting, oppression of bone marrow functions, fever and severe weakness.
CANscript is a unique diagnostic
CANscript provides patients and physicians with a reliable prognosis of the response to cancer treatment and also allows to select a personal treatment protocol for each patient, based on the individual characteristics of his body, the tumor and its reactions to certain drugs.
CANscript generating a treatment prognosis that correlates with clinical results
This new functional test is able to predict treatment results for a particular patient and to avoid ineffective treatment dealt with waste of time, toxicity and high cost.
CANScript assesses tumor response for actual treatment
Unlike other tests that classify patients into groups with profiling genomic cancer or manipulate and deform tumor, which leads to a low correlation with the patient’s response, CANscript carefully reproduces the unique tumor microenvironment and ecosystem to assess the individual tumor response to the treatment chosen by the physician, in real time.Thus, the test results can show what will happen when the patient is actually treated.
The result of this test is a higher correlation with clinical results, greater clinical benefit and a significant advancement of truly personalized care.
CANScript tests each modern anticancer drug
CANscript provides a number of significant kinetic and terminal tests to estimate clinical response to each treatment being tested. The platform uses a complicated, clinically prepared method to provide a prognosis for a response to treatment that has been tested with a high correlation to the clinical result.
In order to determine if the test is suitable in your case, please send us medical reports and the current status of the patient, for consultation with our expert.
In case of approval by doctor, the patient should come to Israel and undergo an examination:
- blood test;
- biopsy procedure;
- oncologist’s consultation.
A high correlation of CANscript predictions with actual clinical results was demonstrated and documented in peer-reviewed publications and major presentations of international medical conferences.