Determining the Best Treatment for YOUR Cancer
- Genomic profiling of tumors; Although standard protocols for chemotherapy still exist for each cancer, physicians are aware that these protocols are only effective for a subset of patients. This issue has spawned the development of many companies that examine the genes of your particular cancer. At AMT, we recommend this testing be performed on tissue that has been resected, although the efficacy of this modality has been limited.
- Benefits; Occasionally a mutation is found through genomic evaluation that reveals a “driver” mutation, ie., a mutation that is spearheading the growth of the cancer.
- Disadvantages; Although genomic evaluation of cancer tissue is commonly ordered by oncologists, the success in improving survival has been modest. The Profiler Trial, a study in France of 1,944 patients with advanced cancer, looked at survival in patients who received targeted treatments based on the genomic evaluation, vs. those who did not. At 3 years, 53.7% of patients who received the recommended targeted therapy were alive, compared with 46.1% of patients who did not. The 5-year survival rate was also higher for patients who received targeted therapy (34.8% vs 28.1%).
- Whole cell cytometric profiling is a process whereby living cancer cells obtained from each patient (via live tissue samples) actually are exposed to the broadest possible range of candidate chemotherapy drugs and the true cell killing ability of each drug, that of which is precisely measured in real-time and in the presence of each patient's own, living cancer cells. In addition, cytometric profiling clearly identifies the widely varying difference in the susceptibility of each patient's cancer cells to different anti-cancer drugs within the same class of drugs. Oncologists often see differences in patient response to different drugs which are thought to work via the same general mechanism. Furthermore, this process measures the combined effect of all cellular gene and protein interactions occurring within the cancer cell. Millions of these are known to occur but most are not yet identified or fully-understood.
Finally, cytometric profiling also has the proven ability to identify synergy which frequently occurs in rationally-selected drug combinations. Drugs which are only moderately active as single agents, sometimes becoming extremely effective when combined with certain other agents. Cytometric profiling can pinpoint these drug combinations. See Weisenthalcancer.com. Whenever possible, sending living cancer cells, through either a fresh live tissue biopsy, or obtaining fluid from the abdomen or lungs, is advised to optimize a treatment regimen.
- Liquid Biopsy; We now have the ability to detect tumor mutations through a “liquid biopsy,” meaning, through a blood draw. Most individuals with cancer have cell-free tumor DNA circulating in the bloodstream. The genes of the DNA can be analyzed for mutations, similar to analyzing the genes from a piece of malignant tissue. Why is a liquid biopsy necessary, especially if we already have looked at the gene mutations in the original tissue? Cancer is a dynamic disease, which rapidly mutates, especially in response to treatment. The mutations that we see in circulating DNA in the blood may be different from that which we saw on the original tissue biopsy. These new mutations from a blood specimen represent the next generation of your cancer. If your previous cancer treatment is no longer effective, a blood biopsy may reveal new mutations for which we can use a targeted drug, that may be effective for your cancer. There are several labs that offer this service, such as Guardanthealth.com and Foundationmedicine.com.