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Personalised Treatment

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Humans have tens of thousands of genes. When one is exposed to carcinogens, radiation, viruses, or infection for an extended period of time, genetic mutations can result, leading to an abnormal growth in cells and thereby cancer. For treating patient cancer, it is necessary to identify how the cancer cells grow and divide so that the patients can be treated with more individualised medical treatment plans to optimise clinical outcome. Currently, genetic testing has been used to help patients with lung cancer, breast cancer, or ovarian cancer to develop a cancer treatment plan that meets their needs.

 

Personalised cancer therapy has been gaining traction as a new medical development in cancer treatment. Instead of relying on the stage and type of the cancer, doctors can, after identifying the nature and genetic sequences of cancer cells through advanced genetic tests, then target cancer cells with the new generation of precision medicines, including targeted therapy and immunotherapy. Regardless of the type of cancer, genetic tests can identify the mutated genes and allow precision medicines to effectively target and attack cancer cells without being restrained by the location of the cancer tumour.

What are the benefits of personalised therapy?

Personalised cancer therapy and genetic tests allow a more precise targeting of cancer cells, not only improving the effectiveness of treatment and chances of complete recovery, but also reducing the side effects on patients. From screening and diagnosis to treatment, personalised cancer therapy is carried out by a Multi-Disciplinary Team (MDT) that consists of specialist medical professionals across disciplines working together to develop the most suitable treatment plan to meet the needs of the patient. HKIOC has always been on the forefront in introducing new medicines registered in the USA and Europe, allowing for a wide range of treatment combinations.

 

An Australian medical study found that the survival rate of patients who received MDT cancer treatment was higher than that of those receiving general cancer treatment. In 2015, a local medical institute conducted an observational study with 586 early-stage cancer patients to investigate the effectiveness of MDT in cancer treatment. The results demonstrated that the five-year survival rate of patients receiving MDT cancer treatment was 63.1% with a median of 16 months, while that of patients who received general cancer treatment was just 48.2%.

The purpose of genetic testing for cancer

Genetic testing is mainly used for two purposes: cancer prevention and treatment. It is performed on a sample of blood, hair, skin, or other tissue. The results usually take weeks or even longer to return. In recent years, liquid biopsy has been increasingly applied to diagnostic tests. This method is able to identify genetic mutations through the sampling and analysis of non-solid biological tissue such as blood, pulmonary oedema, pericardial fluid, and cerebrospinal fluid. Because this method is a non-invasive alternative to surgical biopsies, liquid biopsy has been named by MIT as one of the “10 Breakthrough Technologies”. It is particularly suitable for patients with advanced cancer or for those who are old and weak to undergo surgery for tissue biopsy, as the test can be done with a sample of blood.

 

There have been major advances in molecular biology in the past years, one of them being Next Generation Sequencing technology (NGS). This cutting-edge technology has been applied clinically, enabling researchers to conduct DNA sequencing much more quickly with high levels of accuracy. This provides a wealth of disease information for medical teams to carry out analysis on patient cancer with more precision at the various different stages.

TREATMENT

Cancer patients can undergo a genetic test to look for specific genes, opening up possibilities for new combinations of therapy.

 

Conventionally, molecular genetic tests are performed on cancer patients. Each tissue sample taken can only be used for three different genetic tests. With the new genetic sequencing technology, biopsy is needed only once to identify all the biomarkers and 300 different types of genetic mutations in cancer cells.

 

Taking lung cancer as an example, if there is a mutation in the epidermal growth factor receptor (EGFR), patients can opt for precision medicines to identify the growth of cancer cells and attack them with accuracy. Unlike traditional chemotherapy, this treatment method minimizes the damage to normal cells and thus significantly reduces the side effects on the patients. It is also more effective at treating cancer.

PREVENTION

Patients who have a family history of cancer can assess their risk of cancer and formulate plans to monitor and prevent cancer through genetic tests. About 50 hereditary cancer syndromes have been identified so far.

 

With ovarian cancer as an example, patients with BRCA mutations have 10 to 50 times higher risk of developing breast cancer and ovarian cancer, respectively, as compares those who don’t have these mutated genes. 1% of females experience BRCA1 or BRCA2 genetic mutations. Among those who are diagnosed with breast cancer, about 10-15% of them are found to have one of these two genetic mutations.

New personalised therapy options

TARGETED THERAPY MEDICINES

This therapy option uses drugs or other substances to block the growth and spread of cancer by interfering with the cancer’s specific genes, proteins, or the tissue environment that contributes to the cancer growth. For example, Crizotinib, a tyrosine kinase inhibitor, is used to treat ROS1 positive lung cancer and studies have demonstrated that over 70% of lung cancer patients who took Crizotinib found their tumours reduced and experienced no disease progression for 16 months after taking it.

IMMUNOTHERAPY

Immunotherapy helps improve or restore immune system function to identify and attack cancer cells by blocking the signals transmitted by cancer cells. In other words, T-cells are a type of immune system cells that can attack cancer cells. However, when cancer cells are bound to immune checkpoint inhibitors such as PD-1, T-cells are kept from killing cancer cells. Anti-PD-1 immunotherapy drugs restore the function of T-cells and help destroy cancer cells.

 

At the moment, 7 types of immunotherapy drugs have been approved by the FDA (USA) to be used in the treatment of dozens of cancers including lung cancer and liver cancer. At the same time, over 2,500 clinical trials have been carried out across countries to investigate the applications of immunotherapy in cancer treatment.

COMBINED THERAPY

Apart from the use of new-generation precision medicines, personalised cancer therapy also includes combined therapies that are specially designed based in the patient’s condition and individual needs. Patients who were previously deemed as ineligible for surgery may receive chemotherapy to shrink the tumour, thus potentially enabling the patient to undergo a surgical resection. Furthermore, it may also be used for some patients to eliminate the remaining cancer cells post-surgery. Doctors can develop a treatment plan based on the patient’s condition and individual needs. For example, allowing them to receive infusion chemotherapy treatment at home or at outpatient cancer clinic at the HKIOC Daycare Medical Centre.

OTHER NEW CANCER THERAPIES

Chimeric antigen receptor (CAR) T-cell therapy is a form of cancer immunotherapy that uses specially altered T cells from the patient’s own immune system to destroy cancer cells. A sample of their T-cells are collected and then modified to produce special structures called CARs on their surface. Currently, it has been approved for use in lymphoma treatment.

BIOTHERAPY

Uses living substances or or suppresses the body’s immune system to help fight the cancer.

References：

  1. https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet
  2. https://www.am730.com.hk/news/%E5%81%A5%E5%BA%B7/%E5%85%A8%E9%9D%A2%E5%9F%BA%E5%9B%A0%E6%AA%A2%E6%B8%AC-%E5%88%B6%E8%A8%82%E6%B2%BB%E7%99%8C%E6%96%B9%E6%A1%88-152313
  3. https://www.hkioc.com.hk/zh-hant/%E5%85%8D%E7%96%AB%E6%B2%BB%E7%99%82%E9%9D%9E%E4%BB%BB%E4%BD%95%E7%99%8C%E7%97%87%E5%90%88%E7%94%A8/
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