Monthly Archives: December 2017

Precision Medicine: From Buzzword to Promise or Reality (Part I)

By Hui Xie-Zukauskas

Target for Precision Med_CPDIn a cheering spirit of the season, an amazing gift for each of us, in a perspective of health and future healthcare, is Precision Medicine. Precision medicine is no longer just a buzzword, its remarkable ability to impact detection, treatment and prevention has extended beyond cancer, and advanced clinical care for cardiovascular diseases, neurological disorders, and other acute or chronic illnesses.

This is an exciting era that treating a disease is transformed from following standard guidelines or the conventional “one-size-fits-all” approach to tailoring of medical treatment to individual characteristics of each patient.

So, what does it mean to cancer treatment and cancer prevention? I’ll provide some remarkable findings for you.

First, Let’s Clarify Precision Medicine vs Personalized Medicine

According to NIH, precision medicine refers to the tailoring of medical treatment to the individual characteristics of each patient, i.e. to identify what approaches will be effective for which patients based on their genetic, environmental, and lifestyle factors.

Precision medicine and “personalized medicine” are interchangeable sometimes. However, the term “personalized medicine” tends to be misinterpreted or misunderstood as the practice that treatments are uniquely designed for each individual. This is not always the case with precision medicine, and I’ll elaborate upon it more in cancer treatment later to help you understand better, so read on.

How Can Precision Medicine Steer Cancer Treatment Precisely?

Cancer is essentially a genetic disease. Errors, defects and malfunctions in the sequence of DNA or changes in the ways how genes are regulated can overthrow a cell’s apparatus, triggering uncontrolled cell growth, and eventually, tumor development.

The cause of these changes can be lifestyle – such as smoking, environmental – such as exposure to toxins, and/or spontaneous – such as a result of mutations in genes or inherited genetic alterations. Furthermore, research findings show that the changes that occur in one person’s cancer may not occur in others who have the same type, and the same cancer-causing changes may be displayed in different types of cancer.

These genetic changes in cancer can be examined using extraordinary technologies such as DNA sequencing, genomic testing and tumor molecular profiling. Samples can be collected by biopsies from tumors or in some cases, circulating DNA from patients with premalignant lesions. Cancer molecular profiling can uncover patients’ genetic variations, transcriptomic or proteomic profiling, tumor metabolism and microenvironment, and tumor immunity.

Considerable evidence indicates that a specific sequence of acquired genomic events over many years characterizes the transition from a normal cell to invasive carcinoma, and that specific “driver” events, developed in a particular order, enable cells to progress from benign growth to a malignant cancer.

Traditionally, tumors from the same organ or anatomical site are treated as one tumor entity. With breakthrough advances in genomics and technology, molecular tumor profiling may identify cancer “drivers” that are shared among different cancer types, prompting an approach to target driver’s pathways across anatomical sites, and clinical trials (so-called umbrella trials) to test whether molecular alterations in one tumor entity can be extrapolated to all other cancers.

For example, an inflammatory signature proved to be shared by seven cancer types including breast, prostate, colon, gastric, pancreatic, oral and lung.  Karyopherin alpha 2, a protein that plays a vital role in causing cancer, is uniformly up-regulated across these cancer types. Hence, a cancer-related molecular inflammatory pattern may position this protein as a uniform marker for poor prognostic cancers. Alternatively, oncologists can use specific drugs that target this protein to stop cancer growth.

Take a look at traditional chemotherapy, it works by killing cells that multiply quickly whether they are normal or cancerous. Precision medicine works differently. Because cancer cells need specific proteins or cancer-causing genes to survive, grow and spread, targeted therapies are designed to go after specific cancer-causing genes or proteins, leading to stopping or slowing down cancer progression.

Collectively, precision medicine can improve diagnostics, treatment, early detection and prevention. The goal of precision cancer medicine is to identify which mutation that drives a tumor, and to target therapies on what and how cancer-causing genetic changes occur in a tumor, no matter where the tumor develops in the body.


Image credit: CanStockPhoto & CPD