The tumor agnostic concept represents another step towards precision oncology, with therapies directly targeting the genetic changes that cause the tumor, regardless of location.
Medicine has taught us many lessons this year. One of these is the importance of a good diagnosis. Screening tests and the different pathways to detect a disease are essential to prevent, as well as many diseases
when deciding what is the best treatment for a patientIt mainly occurs in the case of cancer.
Although in many cases cancer has a curable disease and preventable in others (according to WHO30% of cancer deaths can be prevented by avoiding risk factors such as smoking, poor eating habits or a sedentary lifestyle), it is a disease that still raises many unknowns about their behavior.
Decades of research have paved the way for one of the last areas of treatment, cancer agnostic approachThe most advanced DNA sequencing techniques have one deeper genetic study of tumors, which promotes the discovery of genetic changes (or biomarkers) responsible for certain types of cancer. They are the last piece of information available and they make it possible direct treatments that take into account the genetic characteristics of the tumor, outside the venue and stadium. It is what is known as
precision medicine
For Dr. Rosario García Campelo, head of the oncology service at CHUAC and head of the oncology group at the INIBIC research center, in A Coruña, the most important innovation of recent years is undoubtedly Genomic Characterization of CancerThat dissection that we did of the different tumors, there’s no longer any lung cancer, but
we know different subgroups based on certain genetic changes who have made a personal approach possible ”.
According to Dr. Garcia is lung cancer the best example for understanding the concept of precision medicine. “We started with an authentic one in 2004 biomarker revolution with discovery of EGFR gene mutations and since then the list has not stopped growing ”. Some, like the NTRK gene, illustrate it perfectly: “It has been described in very rare tumors such as childhood tumors and very common tumors such as lung cancer.” More than 700 biomarkers are currently under study.
- Dr. Rosarío García
- Dr. Lara Pijuán
- Dr. Lara Pijuán
Lung cancer is the second most common in the world, with more than 2 million cases per year. They are diagnosed everywhere in Spain 30,000 new cases per year, as estimated by the Spanish Association of Medical Oncology. It is also the most deadly cancer responsible for 20% of all cancer deathsBut on the other hand, it is also one of the diseases with the most progress in recent years, and great strides have been made in reducing mortality, diagnostic techniques and new treatments.
There are two classifications for lung cancer: small cell (small cell) and large cell (non-small cell). First represents only 15% of cases, but it is the most aggressive and it is usually detected in already advanced stages of the disease, with metastases. Research and genetic knowledge of these types of tumors have made it possible to obtain new drugs and therapies as well “It has radically changed the way we understand cancer and especially the way we treat our patients”says the oncologist.
Precision medicine
The success of the so-called precision medicine, as a result of which specialists know which treatments will work for the patient based on the genetic dissection of their disease, depends very much on the diagnosis. “How we diagnose cancer now is nothing like what we did ten years ago. Depending on the ‘name’ we give a tumor, we have to add genetic studies and look for molecular changes, ”explains Dr. Lara Pijuan Andújar, pathologist at Hospital del Mar, in Barcelona.
Molecular changes are what define the concept of tumor agnostic: genetic changes that are responsible for generating the disease, but that
“They can be present in different organs and can be treated in a homogeneous way”, Dr. García. That is, with therapies that target exclusively these biomarkers, cancer cells, without affecting more. For this reason it is so important now give cancer a first and last namesays Dr. Pijuán: “It is not the same to tell the patient that he has a squamous cell carcinoma than that he has an adenocarcinoma.”
A good diagnosis, better treatment
It is estimated that approximately a 30% of lung cancer patients could benefit from these targeted therapiesHowever, to reach everyone with these treatments, access to the best diagnostic tests is vital. Dr. Pijuán believes that “it is something that should be done at the national level, it cannot be that a patient who comes from one place or another will receive another diagnosis “A claim by pathology services because “if we are served well, the patient will always have better treatment”.
The search for these genetic changes has improved significantly in recent years, thanks to mass sequencing technology (next generation sequencing or NGS), which allows “many genes in the tumor to be studied, not just the ones we already know. So we’re adding new information, new genes are emerging that need to be studied to see which drug can go against it ”. In the laboratories of Hospital del Mar, this technology enables pathologists work with panels of between 50 and 200 genes at the same time
Taken together, technological advances in diagnostic testing and targeted therapies have completely changed the approach to the most aggressive form of lung cancer. In addition, the results of new treatments improve those of conventional treatments such as chemotherapy and surgery, with the benefit to patients that “they may have some side effect, but it won’t attack like chemotherapy “, says the pathologist.
The three pillars that currently support cancer treatments are the chemotherapy, targeted therapies and immunotherapyImmunotherapy treatments are already a reality in lung, bladder, kidney or melanoma cancer and are paving the way for its arrival in other cancers such as neck cancer. Immunotherapy works by modifying and modulating the immune system “That the individual’s system is responsible for detecting and eliminating the tumor cell”, Dr. García. The specialists speak of a
“Authentic Therapeutic Revolution”, supported by increasing research. Like immunotherapy, the cancer agnostic approach needs more and better research to continue to make progress.
New therapies are changing the direction of clinical trials
The cancer-agnostic approach also has the design of clinical trialsResearch that has traditionally focused on testing the efficacy of cancer treatment based on location. Now, however, with the identification of molecular changes and the development of targeted therapies, other types of studies have begun to develop, the basket or umbrella tests, in which molecular change takes priority.
Umbrella trials are those investigations different drugs in different circumstances that occur in a particular location: for example, several patients with lung cancer but who show different genetic changes. Basket tests, on the other hand, evaluate the efficacy of a drug for a single conditionregardless of your location. That is, different tumors that share the same biomarker.
The emergence of these new clinical trials has opened the door for you more patients have the opportunity to access agnostic therapiesThey are also of particular importance for the study of rare cancers or unusual changes. Organizations such as the FDA in the United States and the EMA in Europe consider basket studies to be acceptable methods for the authorization of these treatments and thus
to conduct further research into the effectiveness of targeted therapies
Neither cancer nor other diseases have stopped because of the pandemic, despite one 20% fewer diagnoses this year, according to SEOM, but the availability of new treatments, “immunotherapy or precision medicine, has helped us a lot. adapt the treatments of our patientsTo avoid hospital treatment, oral treatments have allowed us to send the medication home and perform checks using telemedicine ”.