Traditionally, cancer has been classified depending on its anatomical location and treatment has been established depending on the affected organ: lung, breast, colon, skin, blood, etc. A person diagnosed with cancer would therefore usually receive the same treatment as other people with the same type and stage of cancer. Even so, individuals could respond differently and until recently doctors did not understand why. After decades of research, scientists now know that patients’ tumours have genetic changes which cause the cancer to grow and spread. They have also learned that changes which occur in cancer in one person may not occur in others with the same type.
Alternatively the changes which lead to cancer can be the same in different types of cancer. For this reason researchers have now known for some time that it is more accurate to differentiate each type of cancer depending on the DNA changes which result in the development of the tumour.
The hope for precision medicine is that one day treatment will be entirely related to the genetic changes in each person’s cancer. The idea of precision medicine is not new, but recent advances in science and technology have helped to quicken the pace in this field of research.
Currently, if you require cancer treatment, you may receive a combination of several treatments: surgery, chemotherapy, radiotherapy and immunotherapy. In general, the treatment you will receive depends on the type of cancer, its size and whether it has spread. With precision medicine, the information relating to genetic changes in your tumour can help to decide which treatments would work best for you.
To understand the genetic changes in your cancer, you may require a biopsy. A biopsy involves a procedure during which your doctor takes a specimen of the tumour. This specimen is sent to a special laboratory, where a machine called a DNA sequencer looks for genetic changes which could be causing the cancer to grow. The process of looking for genetic changes in cancer can be known as DNA sequencing, genomic testing, molecular profiling or tumour profiling.
Targeted therapy is the basis of precision medicine. It is a type of cancer treatment which acts on the changes which encourage growth, division and spread of cancer cells. On gathering more information about the cellular changes which cause cancer, researches have a greater likelihood of creating promising treatments which act on these changes and block their effects.
The majority of targeted therapies use small-molecule drugs or monoclonal antibodies.
● Small-molecule drugs are substances capable of penetrating cells easily due to their low molecular weight. Once inside the cell they can affect other molecules, such as proteins, and cause the cells to die.
● Monoclonal antibodies are drugs which cannot easily enter cells. Instead of acting within, they bind to specific targets which are found on the outer surface of cancer cells. These drugs take advantage of the functions of the natural immune system to fight cancer and can be used in combination with other oncology treatments.
The majority of targeted therapies help to treat cancer by interfering with the specific proteins which promote growth and spread of tumours within the body. They treat cancer in several different ways and can do the following:
● Help the immune system to destroy cancer cells. One of the reasons that cancer cells can survive is because they manage to hide from the immune system. Certain targeted therapies mark the cancer cells, making it easier for the immune system to find and destroy them. Other targeted therapies help to strengthen the immune system so that it works better against the cancer.
● Stop the growth of cancer cells. Healthy cells in the body generally only divide to create new cells when they receive strong signals to do so. These signals bind to the proteins on the surface of the cells, telling the cells to divide. This process helps in the formation of new cells only when the body needs them. But some cancer cells have changes in the surface proteins instructing them to divide even though there are no signals. Some targeted therapies interfere with these proteins and therefore prevent them from telling the cells to divide. This process helps to reduce the uncontrolled growth of cancer.
● Stop signals which help in the formation of blood vessels. Tumours need to form new blood vessels to grow beyond a certain size. These new blood vessels are formed in response to signals which come from the tumour. Some targeted therapies are designed to interfere with these signals and prevent formation of a blood supply. Without a blood supply, tumours remain small. If the tumour already has a blood supply, these treatments can cause blood vessels to die, which in turn reduces the size of the tumour.
● Take destructive substances to the cancer cells. Some monoclonal antibodies are combined with toxins, chemotherapy drugs and radiation. When monoclonal antibodies bind to targets on the surface of the cancer cells, the cells absorb the destructive substances, causing their death. Cells which do not contain the treatment target are undamaged.
● Cause the death of cancer cells. Healthy cells die in a controlled way when they are damaged or are no longer necessary. But cancer cells have ways of avoiding the process of cell death. Some targeted therapies can make cancer cells pass through the process of cell death.
● Prevent the cancer from receiving the hormones it needs for growth. Some breast and prostate cancers require certain hormones for growth. Hormone therapies are a type of targeted therapy which work in two ways. Some hormone therapies prevent the body from producing specific hormones. Others prevent hormones from acting on cells, including cancer cells.
All of this helps us to personalise each individual’s treatment.
Consult us about your case. In Spain our Specialist Consultant Oncologists are leaders in their field, and recognised throughout Europe. They will assess your case and tell you if you might benefit from any of the tests available and which might be the most appropriate treatment for you. The team works in groups of multidisciplinary committees, and their objective is to obtain the best results, in an environment which is comfortable, modern and stress free to help patients feel as relaxed as possible.
May 10, 2018
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