We’re entering a new era of personalized medicine, in which each patient’s cancer therapy is tailored to their genetic composition. Individual tumors can be genetically profiled, and the exact mutations underlying them can be identified through genomic testing. Clinical trials are used to evaluate novel medication candidates or to investigate novel applications for current medications.
In principle, these discoveries might enable doctors to develop tailored therapies for each tumor, resulting in improved patient results. In actuality, however, oncologists are suddenly presented with a deluge of data that is impossible to process. As a result, cancer treatment isn’t always as customized as it could be.
THE CHALLENGE FOR ONCOLOGISTS
As a lymphoma hematologist/oncologist, I know that genetic and molecular specifics on each patient’s malignancy may be obtained and that this information might provide potentially lifesaving hints. However, we don’t always know which molecular diagnostic test is best for each patient.
When we have genetic sequence information, it’s not always apparent what it indicates for a patient’s prognosis. When several research shows diverse uses, it isn’t easy to choose the most promising drug. Several inhibitors of the enzyme anaplastic lymphoma kinase (ALK), for example, have shown to be successful in the treatment of lymphoma, non-small cell lung cancer, and neuroblastoma. At the same time, other data suggest that one of the inhibitors might be used to treat pediatric oncology patients.
In addition, some of us are having difficulty obtaining genetic sequencing and providing precision medications to our patients. Some health insurance companies don’t cover genetic testing or pay a fraction of the cost. Others are hesitant to pay for the usage of off-label drugs.
Oncologists in community settings treating non-small cell lung cancer patients experienced difficulties handling tumor samples, had long turnaround times for laboratory testing, and had limited access to targeted medicines, according to recent research from Hackensack Meridian Health. To make things even more complicated, next-generation sequencing findings are frequently delivered in the form of a pdf, which cannot be digitally merged with a patient’s electronic health information.
Meanwhile, oncologists are struggling to keep up with the rapid advancement of precision medicine science. Oncologists can’t keep up with the updates fast enough to read them all or hear about them at an annual conference. Given that a cancer doctor’s working day is loaded with patient visits and handling accompanying clinical documentation, administrative communications, and insurance paperwork, it’s just too much for an oncologist to study, understand, and apply.
GENOMICS AS A STRATEGY
With so many obstacles to overcome, oncologists need strong support to provide the best cancer treatment possible, and they’re starting to receive it. This assistance can assist them in gaining access to new data, comprehending it, and using it to better care for their cancer patients.
This breakthrough is shown by a recent instance of a seriously sick cancer patient at the Hackensack Meridian Health John Theurer Cancer Center, where I practice oncology. Two biopsies were collected from the patient. Different findings emerged from the investigations, one of which detected an incurable type of cancer. However, the patient’s genetic sequencing found a mutation that indicated a relatively treatable form of cancer. We used a scientifically established treatment on the patient, and he demonstrated significant improvement very soon.
Hackensack Meridian Health and a partner organization, the Genomic Testing Cooperative, have launched an in-house genetic profiling lab to guarantee our patients have access to treatment guided by genomic profiling. The program looks for DNA and RNA mutations and chromosomal structural abnormalities in 434 genes associated with solid tumors. The service generates a 177 gene panel hematological profile for blood malignancies.
We’re also establishing a database at HMH that will enable oncologists to swiftly assess a patient’s cancer and utilize that information to enhance care by correlating genetic results, cancer kinds, cancer treatments, and patient outcomes. Other major cancer hospitals are pursuing similar initiatives.
EXPERTISE THAT IS AUTOMATED
The next stage is to use artificial intelligence to go through all of the information—genomics, medication trials, patient demographics and results, and scientific research—and make a therapeutic suggestion. A clinical decision support system is what this is called (CDS). This is what IBM Watson was built to do, but it wasn’t up to the task. Other prominent technology businesses are developing cancer treatment guiding software. Within a decade, a CDS system that might change cancer care should be available.
Clinical data and National Comprehensive Cancer Network guidelines — a collection of evidence-based recommendations designed to assist healthcare providers in preventing, diagnosing, and treating cancer — will eventually be integrated into a clinical decision support system. It will also incorporate specific patient data and submit it to insurance companies for approval instantly. This would reduce one of the most significant administrative costs faced by physicians.
For the time being, oncologists can obtain the most significant advice from multidisciplinary roundtable talks, including radiologists, pathologists, medical oncologists, and radiation oncologists and surgeons—known as molecular tumor boards. They examine cases, evaluate all available information, and provide therapy suggestions. We, like other health systems, have been holding our sessions remotely during the COVID-19 outbreak. Having a group of qualified professionals review a patient’s genetic testing data and clinical records and compare them to research data is highly beneficial to oncologists, especially those working in small community settings.
Dedicated health care workers will always be required, regardless matter how powerful technology-enabled therapies are. Compassionate physicians, nurses, dietitians, and social workers may treat each patient as a person, with emotional, spiritual, and social requirements in addition to physical ones. Patients with cancer benefit from proper diet, frequent physical activity, and a healthy mental attitude, as well as having appropriate social support
The actual core of customized medicine is a holistic approach to care mixed with tailored cancer medicines, which will give increasingly effective cancer therapy.