Precision Medicine

Understanding Precision Oncology: Personalized Cancer Treatment 

Precision oncology is a transformative approach to cancer treatment that offers individualized therapies for patients based on the genetic and molecular characteristics of their tumors. Unlike traditional methods that group cancers based on where they are in the body (like the lungs, breast, or colon), precision oncology looks at the specific genetic changes or proteins that cause the cancer to grow. These changes often can be treated with drugs designed to target them. 

According to the National Institute of Health, researchers can identify biomarkers – molecular fingerprints used to detect, diagnose, monitor, and guide the treatment of various cancers. In this way, cancer’s one once-broad categories can be divided into far more precise types and subtypes. It is important to know where cancer starts in the body because understanding its location helps make sense of the molecular information. Even if your cancer does not have a perfect genetic match to a drug, precision medicine can still help by ruling out certain types of cancer through testing.

Tumor Profiling and Biomarker Identification 

A patient’s treatment journey begins with a comprehensive analysis of their tumor to identify biomarkers – gene and protein changes, which are important to determine the best treatment. 

These biomarkers can be broadly placed into four categories:

• Predictive biomarkers - These biomarkers are used to select the best treatments.
• Diagnostic biomarkers - These biomarkers can give doctors information about where a patient's cancer began.
• Prognostic biomarkers - These biomarkers can help determine the course of the disease and a patient's life expectancy.
• Pharmacodynamic biomarkers - These biomarkers help monitor the body's response to treatment and determine whether a patient may have severe side effects from certain drugs.

Biomarkers play a vital role in precision medicine by helping doctors choose the most effective, personalized treatments for each patient—leading to better results and fewer side effects.

Understanding Genetic Changes

It is important to understand the difference between two types of genetic changes: 

• Somatic mutations found in tumor tissue and germline mutations found in every cell in the body. Somatic mutations go away when the cancer is cured.
• Germline mutations are contained in every cell in a patient’s body, including the cancer cells. People with germline mutations may need extra or earlier cancer screenings because these changes can raise the risk of developing cancer. These are called risk or susceptibility biomarkers—examples include BRCA1 and BRCA2.

The Brown University Health Cancer Institute is fortunate to be one of a handful of cancer treatment centers in the region with a molecular pathology lab on site. This benefits our patients enormously. 

Once a tissue sample is removed, the biomarker analysis is completed in days, rather than weeks. In many cases, a personalized treatment plan can begin faster than in a hospital without in-house testing.

Advanced Precision Oncology Treatments 

• Targeted Therapy

  • These treatments use drugs that focus on specific cancer cell mutations. They work by blocking the molecules that help tumor grow and spread.
  • Antibody–Drug Conjugates (ADCs): These are special treatments that attach powerful cancer-fighting drugs to antibodies. The antibodies find and stick to cancer cells with potent drugs, helping deliver the drug directly to the tumor while sparing healthy tissue.
  • Personalized mRNA Vaccines: These vaccines use mRNA technology to help a patient’s immune system recognize and attack cancer cells based on individual tumor mutations.

• Clinical Trials

  • Clinical trials are research trials that test how well new precision treatments compared to standard cancer treatments.

Impact of Precision Oncology 

Precision oncology improves clinical outcomes by targeting specific cancer genes, increasing the chance that the very first treatment will be effective by getting the correct drug to the correct patient. Molecular subtyping has also fueled advancements in treatment. 

Precision oncology represents a shift from a one-size-fits-all approach to a more individualized strategy, offering hope for more effective and less toxic cancer treatments.