Personalized medicine, consisting in the treatment of appropriately selected patients with an appropriately selected drug at the right time, is a new chapter in the treatment of cancer patients. The inclusion of a therapy adjusted at the appropriate time, based on the patient’s molecular profile, significantly increases the effectiveness of the treatment and minimizes side effects.
The challenge of our time
It is the disease we fear the most, but also a growing medical, social and economic problem. According to the data of the National Cancer Registry (KRN), over 160 people are registered in Poland each year. new cases and about 100 thousand. deaths. Over 15 million people in our country live with cancer diagnosed in the previous 1 years. Unfortunately, due to the aging of the population and the increased exposure of the population to carcinogens, mainly related to lifestyle, the NCR forecasts are not optimistic – in 2026, approximately 190 people should be expected. new cases [1].
The most common cause of cancer deaths in both men and women is lung cancer. It is estimated that 63 people die in Poland every day, which gives nearly 23 jobs. deaths annually [2]. Lung cancer is the second most frequently diagnosed cancer in men, after prostate cancer, and the second most frequently diagnosed cancer in women, after breast cancer. While the incidence and mortality due to lung cancer have been decreasing in Poles for over a dozen years, they have been steadily increasing in the case of Polish women. Most patients develop symptoms of lung cancer late, after their disease is advanced, making treatment options limited. Five-year survival is achieved in only 15 percent. sick.
Importantly, lung cancer is a disease with many faces. The two main histological types are non-small cell carcinoma (NSCLC), which covers approx. 80% of cases, and small cell carcinoma (DRP) – the remaining 20%. Both groups of lung tumors behave differently and require an individual therapeutic approach. Experts emphasize that NSCLC patients are more fortunate – in their case, a revolution has been underway for several years thanks to modern drugs, including molecularly targeted drugs aimed at a specific change in cancer cells. Recent evidence of providing precision medicine to patients with advanced NSCLC with the current RET gene fusion is the approval of pralsetinib by the European Commission.
Made to measure
This is the simplest way to describe personalized medicine and molecular diagnostics as its component. Its idea is to adapt treatment methods to the individual characteristics of the patient and his disease. In practice, this means selecting subgroups of patients that are similar in terms of the molecular characteristics of a given biomarker within one disease entity and – as a consequence – using an appropriately selected, much more effective and much safer therapy in a given subgroup of patients. This is in line with the change in the paradigm of medical care – the transition from universalism (one-size-fits-all) to personalized (targeted) treatment.
And although personalized medicine is used in cardiology, rheumatology and neurology, its greatest application is in oncology. In the case of non-small cell lung cancer (NSCLC), the main candidates for targeted treatment are patients with stage III and IV of the disease, who cannot undergo radical local treatment.
Talking about personalized medicine in the context of hope for cancer patients is not enough! In fact, the progress that has been made over the last dozen or so years concerns only the so-called innovative drugs, including molecularly targeted drugs, which use inhibition of molecular mechanisms of cancer formation and progression. When it comes to cytotoxic drugs used in chemotherapy, a method of systemic treatment of malignant neoplasms, we have a constant. Nothing changes. Moreover, if cancer patients are properly qualified for molecularly targeted therapies, the effects are spectacular. Efficacy, i.e. the rate of response to treatment, extension of life and progression-free time, is usually very high, and the side effects are smaller than with classical chemotherapy, which – as we know – is a double-edged sword. On the one hand, it destroys cancer cells, on the other – healthy cells that divide just as quickly. This is where we have nausea, vomiting, hair loss, hematological disorders in the form of decreased immunity, anemia or bleeding. Comparing the overall survival time – in classical chemotherapy, the average survival time of patients with NSCLC in the disseminated stage was approx. 8-10 months with the use of different methods of systemic treatment of first and second-line chemotherapy. At the moment, the medians of survival reach several dozen months, and by using appropriate drugs to break down resistance, we are able to treat patients for even years. I myself have patients with metastases, whom I treat for several years – comments prof. dr hab. n. med. Dariusz M. Kowalski.
Diagnostics weight
A necessary condition for the success of targeted therapy is molecular diagnostics, i.e. thorough genetic evaluation of the patient’s cancer cells and determination of the predicted susceptibility to specific treatment. Unfortunately, as experts emphasize, we have a lot of catching up in the field of lung cancer diagnostics in Poland …
This is confirmed in the report “Lung cancer – 2021. Pharmacological treatment” – a fragmented and uncoordinated model of lung cancer treatment causes the patient to wait months for diagnosis and treatment implementation. Molecular tests are performed in less than 10 percent of patients, the mean time of diagnosis is 10 weeks, and the mean time from diagnosis to drug administration is 52 days, which translates into an average treatment initiation time in patients with lung cancer of over 4 months. Additionally, in many patients cancer is not fully diagnosed in molecular terms – and the patient is prescribed chemotherapy, which is the least effective and most toxic treatment.
If we want to improve the results of lung cancer treatment in Poland, apart from introducing a better valuation of guaranteed services for the use of drugs in the drug program, it is necessary to improve the availability and quality of diagnostics, as well as to develop a network of comprehensive medical care centers for patients with lung cancer – Lung Cancer Units. Please note that molecularly targeted therapies are intended for very small populations. Because the activating mutations in the EGFR gene, i.e. in the epidermal growth factor receptor gene, are approx. 12-13 percent. population of NSCLC patients, rearrangements in the ALK gene – maximum 5%, rearrangements in the ROS1 gene – approx. 3%, and rearrangements in the NTRK gene – approx. 1%. However, if we add it all up, we have almost 50 percent. patients who can be treated with molecular targeting. On one condition: such a patient must go to a good facility that uses Next Generation Sequencing (NGS). At the National Institute of Oncology, we immediately scan the entire genome of the cancer cell, identify possible molecular disorders and qualify patients for treatment, including innovative drugs available in clinical trials – adds Prof. Kowalski.