Contents
Contrary to what we thought, cancer is not a disease of a specific organ, but a genome – its development and growth are caused by abnormalities in cancer cells that occur at the molecular level. This means that the better we get to know its genomic profile, the better the chances of choosing an effective therapy. The paradigm shift in the perception of cancer is at the heart of personalized medicine, hope for millions of patients and challenges for the Polish healthcare system.
He has always been with us …
It is associated with pain, powerlessness and a lack of prospects. It is a diagnosis that arouses the greatest fear in the collective consciousness. This is how we perceive cancer, the second cause of death in Poland.
The fact that cancer is a growing health and economic problem in Polish society is evidenced by statistics – the number of cancer cases in Poland has more than doubled in the last three decades, and forecasts indicate that in the next 10 years the increase will reach 28%. According to the forecasts of the National Cancer Register (KRN), approximately 2026 jobs should be expected in 190. illnesses annually.
And although we perceive neoplastic diseases as the scourge of the present day, they have always been present. Already Hippocrates, considered the father of medicine, described breast cancer, and modern research indicates the presence of traces of neoplastic changes in mummified bodies from thousands of years ago. The oldest method of treatment, i.e. surgery, also dates back to antiquity. What has changed then? What is most important, i.e. our knowledge of cancer pathogenesis, opening a new chapter in the fight against cancer.
From “organ oncology” to “precise oncology”
Until recently, cancers were classified according to the part of the body and the organ in which they developed: cancer of the lung, breast, intestine, pancreas. However, the development of modern diagnostic techniques, genetic and molecular tests as well as artificial intelligence (AI) has led to a change in the perception of neoplastic disease.
It turned out that tumors that look identical at first glance under the microscope may differ from each other at the molecular level. Moreover, some rare gene fusions are found in a wide variety of cancers located in organs that are distant from one another. A good example is the fusion of RET, NTRK or ROS1 genes, which may include sarcomas, breast cancer, head and neck cancer, salivary gland cancer, gallbladder cancer and lung cancer, among others.
What does this mean in practice? First, cancer should be viewed as a disease not of an organ, but of individual cells, in genes where pathogenic errors (mutations) have occurred, resulting in uncontrolled tumor growth. Secondly, oncological therapy based on universal therapeutic regimens with the use of chemotherapy and radiotherapy gives way to therapy individually selected for a given patient.
It is not so much a progress as a revolution that is changing the care paradigm! This is how we should perceive personalized medicine, which identifies the patient’s differentness (his cancer), which allows the use of a properly selected drug.
The new face of diagnostics?
Molecular testing, genomic profiling, cancer sequencing – although all this sounds complicated, it makes a lot easier. Because just as cancer patients are different from each other, each genomic profile of cancer is different, and the more information we have about mutations occurring in cancer tissue, the more precise and personalized treatment can be.
Hence, modern laboratories more and more often use large-scale sequencing methods and use the Next Generation Sequencing (NGS) technology in oncological diagnostics, which makes it possible to analyze the sequence of entire genes in one diagnostic test, not only their small areas.
NGS is characterized by high sensitivity and specificity, and provides physicians with answers to many important diagnostic, prognostic and predictive questions. In other words: it allows you to choose the therapy that has the best chance of success. As a result, personalized treatment is in many cases more effective and less toxic than chemotherapy.
Moreover, analysis of many genes related to oncogenesis can indicate whether a patient is resistant or sensitive to the use of a particular treatment.
More than worth it …
Although targeted treatment is a relatively young therapeutic approach, it is undoubtedly one of the most important achievements of modern oncology, constantly evolving and developing through the intensive work of biologists, geneticists, bioinformatics, biotechnologists, pharmacologists and doctors.
Personalizing the treatment allows not only to significantly extend the patient’s life while maintaining satisfactory quality, but also reduces the risk of side effects. This is why financial investment in personalized medicine is increasing around the world. The result is over 200 targeted anti-cancer therapies approved for clinical practice, and many more at the stage of clinical trials.
Although targeted therapies are currently the most effective form of treatment for cancer patients, and access to them increases every year, many patients are still unable to treat them in line with current medical knowledge.
As it turns out, the biggest problem is the availability and quality of cancer diagnostics. An example is lung cancer, for which the lack of a standardized, fast and comprehensive molecular diagnostics pathway constitutes a significant barrier to access to reimbursed, modern therapies for NSCLC (Non-Small Cell Lung Cancer), which does not allow them to fully use their therapeutic potential.
According to the report “Lung cancer – 2021. Pharmacological treatment” molecular tests are performed in less than 10% of patients. sick. The average time of diagnosis is 10 weeks, and the average time from diagnosis to drug administration is 52 days, which is much too long. In addition, in many patients cancer is not fully diagnosed in molecular terms and the patient is given chemotherapy, which is the least effective and most toxic treatment.
Another problem is the quality of the tissue or cytological material in patients with a highly advanced disease. According to the report of the Supreme Audit Office (NIK) from 2020, over 90 percent. patients who came to the outpatient clinic of the National Institute of Oncology who had undergone prior diagnosis did not have a study description that could be the basis for making a decision on the patient’s treatment.
Hence – as experts point out – the urgent need of Polish oncology is to improve the coordination of activities in the diagnostic and therapeutic process with the use of funds from the Medical Fund. Especially since, as they argue, the investment in a good, effective therapy allows to reduce the remaining costs related to the treatment of the patient: hospitalization, treatment of complications, absenteeism and the need to treat relapses.