The concept of tumor agnosticism is an additional step towards precision oncology, with therapies that directly target the genetic changes that cause the tumor, regardless of its location.
This year, medicine has taught us many lessons. One of them is the importance of a good diagnosis. Screening tests and different ways of detecting a disease are essential in the prevention of many diseases, but also
when deciding what will be the best treatment for a patient. It is especially important for cancer.
Although cancer has in many cases become a curable disease and in others, prevented (conformable WHICH, 30% of cancer deaths could be prevented by avoiding risk factors such as smoking, poor eating habits or sedentary lifestyle), is a disease that continues to raise many unknowns about their behavior.
Decades of research have paved the way for one of the latest areas of treatment, the agnostic approach to cancer. The most advanced DNA sequencing techniques have made it possible deeper genetic study of tumors, favoring the discovery of genetic changes (or biomarkers) responsible for certain types of cancer. There is the latest information available and I allow it direct treatments taking into account the genetic characteristics of the tumor, beyond its location 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 main innovation in recent years has undoubtedly been “Genomic characterization of cancer. The dissection I did about the different tumors is no longer a single lung cancer, but
we know various subgroups based on certain genetic changes which allowed a personalized approach ”.
Lung cancer is the best example to understand the concept of precision medicine, according to Dr. Garcia. “I started in 2004 with a real one the biomarker revolution with the discovery of EGFR gene mutations and since then the list has not stopped growing ”. Some, such as the NTRK gene, perfectly exemplify it: “it has been described in very rare tumors, such as pediatric tumors, and very common tumors, such as lung cancer.” More than 700 biomarkers are currently being studied.
- 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 each year. In Spain they are diagnosed around 30,000 new cases each year, as estimated by the Spanish Society of Medical Oncology. It is also the deadliest type of cancer being responsible for 20% of all cancer deaths. But, on the other hand, it is also one of the diseases in which the most progress has been made in recent years and great progress has been made in reducing mortality, diagnostic techniques and new treatments.
There are two classifications for lung cancer: small cells (small cells) and large cells (non-small cells). The first represents only 15% of cases, however, it is the most aggressive and is usually detected in already advanced stages of the disease, with metastases. Research and genetic knowledge of this type of tumor have made it possible to obtain new drugs and therapies and “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, which allows specialists to know what treatments will work for the patient based on the genetic dissection of their disease, depends a lot on the diagnosis. “How we diagnose cancer now is nothing like what we did ten years ago. Depending on the “name” we give to a tumor, we need to add genetic studies and look for molecular changes, “explains Dr. Lara Pijuan Andújar, a pathologist at Hospital del Mar in Barcelona.
Molecular changes are what define the concept of tumor agnostic: genetic changes that are responsible for the generation of the disease, but which
“They may be present in different organs and may be treated in a homogeneous manner”, determines Dr. García. That is, with therapies aimed exclusively at these biomarkers, at cancer cells, without affecting more. That’s why it’s so important now gives cancer a first and last name, says Dr. Pijuán: “It is not the same to tell the patient that he has squamous cell carcinoma than that he has adenocarcinoma.”
A good diagnosis, a better treatment
It is estimated that around 30% of lung cancer patients could benefit from these targeted therapies, but for these treatments to reach everyone, access to the best diagnostic tests is vital. Dr. Pijuán considers that “it is something that needs to be done at the national level, it is not possible for a patient who is from one place or another to receive a different diagnosis. “. A statement made by the pathology services because “if we are well served, the patient will always have a better treatment”.
The search for these genetic changes has improved significantly in recent years, due to the mass sequencing technique (next-generation sequencing or NGS), which allows the study of many tumor genes and not just those we already know. So, we add new information, new genes appear that need to be studied to see what drug can go against it. ” In Hospital del Mar laboratories, this technology allows pathologists works simultaneously with panels between 50 and 200 genes.
Taken together, technological advances in diagnostic testing and specific therapies have completely changed the approach to the most aggressive type of lung cancer. More, the results of the new treatments improve those obtained with conventional treatments such as chemotherapy and surgery, with the benefit to patients that “they may have some side effect, but will not attack like chemotherapy “, says the pathologist.
The three pillars that currently support cancer treatments would be chemotherapy, specific therapies and immunotherapy. Immunotherapy treatments are already a reality in lung, bladder, kidney or melanoma cancer, paving the way for its arrival in other cancers, such as throat cancer. Immunotherapy works by modifying and modulating the immune system “That the individual’s system is responsible for detecting the tumor cell and removing it”, developed by Dr. García. Specialists talk about a
“Authentic Therapeutic Revolution”, supported by more and more research. Like immunotherapy, the agnostic approach to cancer needs more and better research to continue progress.
New therapies are changing the direction of clinical trials
The agnostic approach to cancer has also changed the design clinical studies. Research that traditionally focuses on testing the effectiveness of cancer treatment depending on its location. Now, however, with the identification of molecular alterations and the development of targeted therapies, other types of studies have begun to be developed, tests with baskets or umbrellas, in which molecular alteration is a priority.
Umbrella studies are the ones that study different drugs in different conditions which occur in a certain location: for example, several patients with lung cancer, but who have different genetic changes. Basket tests, on the other hand, evaluate the effectiveness of a drug for a single disorderregardless of your location. That is, different tumors that share the same biomarker.
The advent of these new clinical trials has opened the door more patients have access to agnostic therapies. They are also of special 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 pimple studies to be acceptable methods for authorizing these treatments, and so on.
further research into the effectiveness of targeted therapies.
Neither cancer nor other diseases were stopped due to the pandemic, despite the fact that it had a 20% fewer diagnoses this year, according to SEOM, but the availability of new treatments, “immunotherapy or precision medicine, have helped us a lot we adapt the treatments of our patients. To eliminate hospital attendance, oral treatments allowed us to send the medicine home and perform checks using telemedicine.