Tai­lor thy treat­ment

Down to Earth - - HEALTH -

Per­son­alised­cancerther­a­py­is­de­signed­byi­den­ti­fy­ing­tu­mour­biomark­ers which­can­be­ge­net­ic­ma­te­ri­als,pro­teinormetabol­icpro­filethat­can pre­dict­thep­a­tient'sre­spon­se­toaspeci­fic­ther­apy Ge­netic/molec­u­lar

pro­fil­ing ac­tu­ally re­ceived tar­geted ther­a­pies.”Be­sides, in some pa­tients the ther­apy abruptly stops work­ing for un­known rea­sons.

Mar­tine Pic­cart, pres­i­dent of the Euro­pean So­ci­ety of Med­i­cal On­col­ogy (esmo), in a pa­tient’s guide re­leased in 2013 ad­mits this lim­i­ta­tion.“Cur­rently,we are not yet in the era of per­son­alised on­col­ogy but in the era of strat­i­fied on­col­ogy, which means we are able to clas­sify can­cers ac­cord­ing to crit­i­cal tar­gets against which we hope to de­velop ef­fec­tive drugs,”Pic­cart states.Mod­ern tech­nolo­gies such as deep dna se­quenc­ing will be pow­er­ful tools in the fu­ture al­low­ing us to iden­tify dru­gable mu­ta­tions,he adds.

Mak­ing of won­der drugs

At present, per­son­alised ther­a­pies are mostly re­stricted to clin­i­cal tri­als and may take some time to get ap­proved. Re­search is also un­der way to decode can­cer bi­ol­ogy and to find more molec­u­lar weak points in dif­fer-

Prog­nos­tic mark­ers Mark­ers pre­dic­tive of drug

sen­si­tiv­ity/ re­sis­tance

Mark­ers pre­dic­tive of ad­verse events ent types of tu­mours to per­fect per­son­alised ther­a­pies. In re­cent years, a par­a­digm shift has also been ob­served in tar­geted ther­apy re­search wherein re­searchers are now in­creas­ingly fo­cused on ther­a­pies that can trig­ger the im­mune re­sponse against can­cer. The Novem­ber 27, 2014 is­sue of the jour­nal Na­ture pub­lished five stud­ies on per­son­alised ther­a­pies that tar­get im­mune sys­tem to act against can­cer.

For ex­am­ple,cer­tain tu­mours can ex­press a pro­tein called PD-L1. The pro­tein sends the im­mune sys­tem to hi­ber­na­tion when it binds to PD-1 re­cep­tor, and the can­cer cells re­main un­de­tected. Tar­geted ther­a­pies can block ei­ther PD-L1 or PD-1 to ac­ti­vate the im­mune sys­tem.

A study pub­lished in Novem­ber 2014 found that tar­geted ther­a­pies that block PD-1 re­cep­tors are suc­cess­ful in treat­ing blad­der can­cer. The re­searchers used anti-PD-L1 an­ti­body drug to tar­get tu­mour Per­son­lised

drugs in blad­der and found high re­sponse rates from the im­mune sys­tem of the pa­tients.The drug was con­sid­ered a break­through by the US Food and Drug Ad­min­is­tra­tion in Fe­bru­ary this year.

Clin­i­cal tri­als on tar­geted drugs are on full-swing across the world and the key play­ers in­clude global pharma gi­ants such as No­var­tis, As­traZeneca and Pfizer, among oth­ers.Ac­cord­ing to a re­port by ims In­sti­tute for Health­care In­for­mat­ics re­leased in 2014, there are cur­rently 374 ex­per­i­men­tal can­cer drugs in mid-stage tri­als, and the global spend­ing on on­col­ogy drugs is ex­pected to reach US $100 bil­lion in 2018.

Although per­son­alised ther­apy for can­cer is well known, the con­cept can be used for treat­ment of di­a­betes, heart dis­ease and Alzheimer’s that are of­ten caused due to ge­netic fac­tors.To sup­port stud­ies on per­son­alised treat­ment for bowel can­cer,asthma,hy­per­ten­sion and lu­pus, UK’s min­is­ter for life sciences, Ge­orge Free­man, in Jan­uary this year un­veiled a US $21 mil­lion fund­ing.That month,US Pres­i­dent Barack Obama also an­nounced a plan for his coun­try to be a world leader in pre­ci­sion medicine.

Per­son­alised ther­apy re­quires ge­netic testing which is not only time-con­sum­ing but also ex­pen­sive. Not all kinds of can­cer have per­son­alised treat­ment op­tions

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