How is cancer treated? - Molecular HealthMolecular Health

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Understanding cancer treatments

Thanks to scientific research, there is a lot of biomedical knowledge about how variants in our genes affect whether cancer medicine is effective, ineffective, or toxic.

The goal of cancer medication is to stop cancer cells growing. The medication, which is a chemical compound, has an effect on the cell, this is called a compound-protein interaction mechanism.

Proteins have many functions in our bodies: they support cell structures and also help cells to communicate with each other. Proteins also catalyze thousands of different chemical reactions in the body. These biological catalysts are known as enzymes. Although not all proteins are enzymes, all enzymes are proteins.

Each protein is made up of strings of amino acids. There are 20 different amino acids amino acidsThese are the molecules used to build proteins. Proteins are made of chains of amino acids, and the sequence of the amino acids is encoded in our genes. in our bodies, and their order defines the function of the protein. The blueprint of a protein is encoded in the DNA – in our genes.

Each change in our genes we can identify is a potential target for medication.

Clinically relevant genes

Medical guidelines Medical guidelinesWritten by experts, using up-to-date evidence, they provide physicians with recommendations on the best care options. typically refer to between two and ten genes per disease that are clinically relevant, in terms of their effect on medication. In fact, there are over 250 genes, across all cancer diseases, for which clinical evidence is available related to effectiveness, ineffectiveness, and toxicity. The FDA calls this information a “pharmacogenetic association.”
A diagnostic test diagnostic testAlso called genomic profiling, genetic tests, or molecular diagnostics. These are medical diagnostic tests that check whether variations (variants) are present in a person’s genetic code (genome) that tell physicians about the type of cancer they have and how their disease may react to specific drugs. This combination of gene and drug information is called biomarker, from biological + marker. of your tumor using the next-generation sequencing technique (NGS), or another multi-gene genomic analysis approach, and covering a gene panel of at least 250 genes, or whole exome (WE) sequencing, makes sense, to get the full picture of the genomic genomicThe study of genes and their functions. Cancer genomics studies the DNA of cancer cells compared to healthy cells. determinants of the effectiveness, ineffectiveness, or even toxicity of certain medications for you.

What is chemotherapy?

The goal of chemotherapy is to destroy cancer cells. Chemotherapy drugs disrupt the processes of cell growth and division of all the cells they come into contact with. This means that chemotherapy affects healthy cells and cancer cells alike. As cancer cells multiply more quickly than healthy cells, they are proportionately more affected than healthy cells. Compared to newer targeted treatments that specifically disrupt processes taking place in cancer cells, chemotherapy can be significantly less effective, depending on the type of cancer disease. As chemotherapy works throughout the whole body, it can cause strong side effects, such as nausea and fatigue. Usually a combination of several different chemotherapy drugs is prescribed.

Chemotherapy drugs work in different ways. Here are some examples:

  • Gemcitabine attacks cancer by interrupting the DNA synthesis, leading to cell death (apoptosis).
  • Alkylating agents such as Cisplatin and Carboplatin prevent cells from reproducing.
  • Paclitaxel and Vinblastin belong to the plant-based alkaloids, they work by stopping the process of cell division. They can also starve the cancer cells, by targeting the enzymes they need to grow.
  • Methotrexate is an example of an antimetabolite. It prevents the cancer cell’s DNA from making copies of itself.
  • Cell growth inhibitors block the growth factors that trigger the cancer cells to divide and grow.
Chemotherapy may be chosen as a primary treatment for a cancer of the blood or a cancer that has spread to multiple sites. It may be chosen as a supporting treatment (“adjuvant”) in conjunction with a different primary treatment, for example, to shrink a tumor in preparation for surgery (“neoadjuvant”), or to destroy cancer cells that may remain after surgery. It may be chosen with the goal of minimizing symptoms caused by the growth of the cancer. Many chemotherapy drugs have been available for cancer treatment for quite a long time and are relatively inexpensive (under 2,000 USD per year).

How does chemotherapy work?

chemotherapy

What is targeted therapy?

Like chemotherapy, targeted therapy uses drugs to destroy cancer cells. Unlike chemotherapy, targeted therapy targets either the cancer’s genes, the proteins the cancer cells need to function, or the tissue they are surrounded by, to slow down the cancer growth and kill cancer cells.

 

Before a physician can prescribe a targeted therapy, a patient’s genomic variants need to be identified, so a genomic test genomic testAlso called genomic profiling, genetic tests, or molecular diagnostics. These are medical diagnostic tests that check whether variations (variants) are present in a person’s genetic code (genome) that tell physicians about the type of cancer they have and how their disease may react to specific drugs. This combination of gene and drug information is called biomarker, from biological + marker. is a prerequisite for targeted therapy. The cost of the test may be reimbursed, depending on the cancer disease.

 

Targeted therapy uses either monoclonal antibodies to block signals from cancer cells, or small-molecule drugs to prevent cancer cells from thriving and multiplying.

 

Targeted therapies are only effective if the target is present in the tumor.

What is targeted therapy used for?

If your physicians know the unique genomic genomicThe study of genes and their functions. Cancer genomics studies the DNA of cancer cells compared to healthy cells. variants in your cancer, they can choose a drug that targets these specific variants, increasing the chance that the treatment is effective.

 

This is called personalized medicine, or precision medicine precision medicinePhysicians use genomic diagnostic tests to find the medication that will work best for each patient. .

 

During the last ten years, a number of new drugs have been developed that directly target specific cancer cells containing specific, known genomic variants. Drugs for targeted therapies are still relatively expensive (50,000 to 150,000 USD per year). If you volunteer to take part in a clinical trial testing a new medication, the cost of treatment may be paid by the company sponsoring the trial.

How does targeted therapy work?

What is immunotherapy?

Immunotherapy does not kill cancer cells directly; it works indirectly against the disease by stimulating a patient’s immune system to attack cancer cells. The immune system learns to recognize cancer cells and blocks their growth. As immunotherapy works with substances derived from living organisms, it is also called biological therapy, biotherapy, or biologics.

What is immunotherapy used for?

Immunotherapy is often used when standard treatments have proven ineffective, and has achieved excellent results in some cases, causing tumors to shrink and keeping the cancer in check longer than chemotherapy, with relatively mild side effects. As immunotherapy works by suppressing the immune system, there is an increased risk of infection.

 

Cancer patients who are likely to benefit from immunotherapy can be identified by a genomic test genomic testAlso called genomic profiling, genetic tests, or molecular diagnostics. These are medical diagnostic tests that check whether variations (variants) are present in a person’s genetic code (genome) that tell physicians about the type of cancer they have and how their disease may react to specific drugs. This combination of gene and drug information is called biomarker, from biological + marker. that checks whether a certain biomarker is present.

 

Immunotherapy is relatively new and therefore still relatively expensive. It is already reimbursed for some cancers.

What is immunotherapy used for?

 

Explanations of medical and technical terms

An actionable variant or biomarker is a variant identified in a patient’s genetic test that makes the cancer grow and that can be targeted by a medicine known to be effective against that combination of variant and cancer.

These are the molecules used to build proteins. Proteins are made of chains of amino acids, and the sequence of the amino acids is encoded in our genes.

A measurable indicator that can be identified in your tumor genome or your blood. Some biomarkers provide physicians with information about how patients with a specific disease will react to a specific drug. Testing for biomarkers is important for cancer patients. Also called variants, mutations, alterations, or gene defects.

This is a procedure by which your physician collects a small sample of cells from your cancer for testing in the lab. Depending on the cancer type, the cells are either taken from the tumor itself, or from bone marrow, or from skin.

A segment of DNA or RNA, with information on how the amino acids of a protein are encoded. Most genes have multiple exons.

The study of heredity. If you are born with a cancer-causing gene variant inherited from your mother or father, you have a higher risk of developing cancer. This type of cancer is called hereditary cancer.

The study of genes and their functions. Cancer genomics studies the DNA of cancer cells compared to healthy cells.

Also called genomic profiling, genetic tests, or molecular diagnostics. These are medical diagnostic tests that check whether variations (variants) are present in a person’s genetic code (genome) that tell physicians about the type of cancer they have and how their disease may react to specific drugs. This combination of gene and drug information is called biomarker, from biological + marker.

The basic building blocks of DNA and RNA

Written by experts, using up-to-date evidence, they provide physicians with recommendations on the best care options.

Also called genomic tests, genomic profiling, genetic tests, or molecular diagnostics, are medical diagnostic tests that check whether variations (variants) are present in a person’s genetic code (genome) that tell physicians about the type of cancer they have and how their disease may react to specific drugs. This combination of gene and drug information is called biomarker, from biological + marker.

The median length of time patients are on a specific treatment before their cancer starts growing again.

Physicians use genomic diagnostic tests to find the medication that will work best for each patient.

The length of time patients are on a specific treatment and still alive.

A procedure by which tissue is surgically removed from your body, for example, to remove all or part of a tumor. Cells can then be collected from the tumor for testing in the lab.

The preparation and fixation of the sample for the lab. This is important for the accuracy of the interpretation of the genomic test results.

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