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Imagine a scenario where an individual is diagnosed with a type of cancer, and physicians only need to prescribe a treatment that is specific and optimized to that individual and the type of cancer, with little or no undesirable side effects. That is the goal of precision medicine in cancer care. Precision medicine has become a “buzzword” in the research field and understandably so – according to the National Cancer Institute, precision medicine is “a form of medicine that uses information about a person’s genes, proteins and environment to prevent, diagnose and treat disease.
Fig 1: Cancer Treatment Approach
Before recent advances in cancer research, when an individual is diagnosed with cancer, they are usually treated with commonly and generally used well-known options (Fig 1) such as DNA damaging agents and surgery. However, due to advances in cancer research, there has been a phenomenal development in cancer treatment even as cancer cells have expanded. This development has resulted in discovering various treatment options to improve treatment specificity and overall patient survival rates while reducing treatment toxicity and patient drug resistance. In cancer research, precision medicine involves understanding the genomic or phenotypic nature of cancer-specific to an individual or a subpopulation and developing treatment options specific to such persons that directly target the cancer cells. This recent development has changed the game and revolutionized cancer treatment as we know it.
Twenty years since the human genome was sequenced in the Human Genome Project, sequencing, genotyping, and proteomics in cancer research have continued to advance and redefine precision medicine. In cancer research, these techniques have aided in cancer diagnosis and prognosis and the identification of genetic variants and cancer biomarkers. With precision medicine, one of the goals is to identify the presence of gene mutations that could determine whether or not cancer would respond to previously known treatment options. This identification is important because there is a possibility that gene mutations in same cancer might be different from one person to another. The knowledge of genetic variations specific to individuals or sub-populations would influence the type of treatment made available to patients.
An example of precision medicine in cancer treatment is seen in breast cancer treatment. Extensive studies have revealed that in breast cancer, treatment options can be classified based on whether the breast cancer is HER2-positive (breast cancer cells that test positive for human epidermal growth factor 2) or Estrogen and Progesterone positive (breast cancer cells that have both estrogen and progesterone receptors respectively). This knowledge benefits knowing the treatment plans suggested to each breast cancer patient.
Indeed, precision medicine is the present and the future of cancer care, and it only makes sense to put a lot of effort into precision medicine. Several biopharmaceuticals or research institutes have focused on exploiting precision medicine to combat cancer. It has represented a beacon of hope to cancer researchers, care providers, and patients. However, there remains the problem of access to the latest advances in precision medicine in most parts of the world. Apart from the limitation of access, some of the common limitations to precision medicine are:
—Cost of genetic analysis per patient
—Cost of treatment
—The challenge of translating the acquired genetic datasets into clinical use
To make precision medicine more accessible and improve its worldwide significance, we must encourage international collaborations so that no particular groups of people are left behind. Also, the need to promote equity regarding access to genomic tests and diversity in clinical research cannot be overlooked. Furthermore, the availability of genomic information across all races, nationality, gender, socioeconomic status, age, and geographical location will be pivotal to developing a robust dataset for drug discovery and design in precision medicine research.
It is a known fact that precision medicine is the “future” of cancer care. Before now, a one size fits all approach was more commonly used in cancer treatment, where patients diagnosed with similar types of cancer are given similar treatment options. This has resulted in different responses and side effects from one patient to another. The emergence of precision medicine and moving away from the one size fits all treatment option for cancer patients is more beneficial and will result in an improved response to treatment.
Edited by Rachel Cherney
Hou, Y.C, Karow, D.S, Caskey, T et al. (2020). Precision medicine integrating whole genome sequencing, comprehensive metabolomics, and advanced imaging. PNAS. 117(6).
Mateo, J, Steuten, L, Aftimos, P et al., (2022). Delivering precision oncology to patients with cancer. Nature Medicine. 28(658-665)