Advancements in Precision Medicine Targeting Cancer

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Clinical trials of precision medicine targeted therapies have lengthened the lives of patients with advanced cancers. Estelamari Rodríguez, MD, MPH, a thoracic oncologist at Sylvester Comprehensive Cancer Center and associate director of Community Outreach, explains the goals and achievements of these advancements and clinical trials of personalized therapies.

Estelamari Rodriguez, M.D., M.P.H.

How is precision medicine used in cancer treatment?

When a patient is diagnosed with cancer, it is essential to understand how long the tumor has existed, where it originated, and the genetic changes that caused abnormal growth. By understanding genetic changes and biomarkers, we have helped develop targeted therapies that are more effective because they respond to the molecular changes that drive tumor growth. Next-generation sequencing (NGS) is a molecular test that rapidly analyzes a tumor's DNA to identify these cancer-promoting genetic changes. With this genetic information, precision medicine can identify targeted therapy options or clinical trials, according to their specific profile, to offer better alternatives for the patient.

How are precision medicine and biomarker tests performed on the patient?

NGS is a molecular test that rapidly analyzes a tumor's DNA to identify genetic changes that promote cancer. These tests are traditionally done in the tumor biopsy. This technology is now more available to patients and covered by health plans.

We also have new technologies such as a liquid biopsy to examine cell-free tumor DNA (ctDNA) in the patient's blood (plasma). This technology tends to be less invasive than a traditional needle biopsy, which carries risks such as bleeding and infection. Liquid biopsy can also be cheaper and with earlier results, usually, seven to ten days, which allows us to start the indicated treatment earlier for the patient.

What is late-stage cancer, and how can precision medicine help patients with advanced cancers?

The late stage defines tumors that have spread to other organs outside of where they originated and have metastases. The goal of treatment for these patients is to control the disease and maintain the best quality of life. Advances in cancer treatments have resulted in late-stage patients surviving better than ever before. Precision medicine can help late-stage cancer patients in two ways: one is to define the tumor more precisely to choose a more effective and tolerable treatment, but the other important part is to discover new treatment options for the patient.

How can clinical trials help patients?

Clinical trials can offer the patient an option not available today approved by the FDA. The most critical thing about participating in clinical trials is contributing to science, developing new therapies, and giving patients options that are not currently available otherwise. Also, as part of the clinical study, patients have access to more specialized treatments with more medical care and more frequent health checkups. Research has shown that patients who participate in clinical trials may have better outcomes than those receiving standard therapies. And it is essential to note that the primary goal of the clinical study is not to experiment, but rather, to find a better treatment for the patient.

What are the exciting recent developments?

The most exciting recent developments in lung cancer are therapies targeting specific genetic changes and immunotherapy. Immunotherapy has become an essential part of treating various types of cancer. We are discovering new ways to work with the patient's immune system to fight cancer more permanently and with fewer symptoms. Today, there are patients diagnosed with advanced cancer who are in complete remission after receiving immunotherapy therapy and continue to respond after stopping treatment.

What are the barriers that Hispanics face to participating in clinical studies?

The proportion of Hispanics participating in clinical trials currently does not correspond to the number of Hispanics in society. Analysis of studies that have approved new treatments in the last 20 years shows that Hispanics only represent 6% of the patients who participated in those studies. The first barrier that Hispanics face is limited access to specialized research centers with experimental therapies due to location, transportation, and health coverage. Another critical barrier is language and a lack of information in the community about the benefits of participating in clinical trials.

It is essential to include more diverse patients to achieve valid results extrapolated to the entire population. If Hispanic patients do not participate in these studies, our knowledge of the effectiveness and tolerability of these medications in our Hispanic population is more limited. At the University of Miami, we have a clinical team that is culturally akin to the patient. This dedicated team is spreading the word about clinical trials and how to make these trials more accessible to our population. Many of my Hispanic patients do not make decisions alone but with their families. That is why as part of the patient consent process, we involve the family in a way that respects the patient's culture. Increasingly, we are using telemedicine to explain the clinical trial process and engage the family, so patients understand the options available.

 


Cory Zaccharia is a contributing writer for UMiami Health News.