What if treatment for cancer could be personalised to meet each patient’s needs? What would this mean for the future? Higher success rates in beating the disease? Targeted treatment and the avoidance of unnecessary side effects? Cost savings for the NHS? In a nutshell, all of the above – and that’s exactly what Cancer Research UK is working towards with its new Stratified Medicine Programme, which will launch by the end of the year.
There’s no longer a one-size-fits-all attitude when it comes to cancer treatments and now genetic testing of tumours could be used to guide treatment decisions to determine which drugs are most likely to benefit patients.
By having a routine tumour genetic testing system, doctors would be able to make informed decisions as to which treatments would work best on different types of cancer.
Breast cancer is the most common cancer in Britain, accounting for more than a quarter of all cancers in women. In 2008 around 48,000 people were diagnosed with the disease and it claimed around 12,100 lives. The good news is that almost two-thirds of women diagnosed with breast cancer today now survive the disease beyond 20 years.
Between 20 and 25 of every 100 women diagnosed with early breast cancer have a cancer that produces too much of the HER2 protein. Doctors call this HER2-positive cancer.
There is already a drug on the market, called Herceptin, which is available for tumours – including breast cancer – with certain biological characteristics. It involves testing patients for the HER2 protein. Technically, this is not a genetic test but it looks at receptors on the surface of the tumour and is a good example of a targeted, or stratified, medicine.
Herceptin only benefits people whose cancer is HER2-positive, which is up to 30 per cent of women.
Herceptin was licensed in 2000 and has seen positive results in breast cancer patients since that time. This new project aims to work out how testing for targeted drugs such as Herceptin can be made routine and standardised for all cancers, as well as capturing the information for further research.
‘We’re trying to work out if there’s a better way of targeting the treatments for individual tumours by testing those tumours for certain markers,’ says James Peach, director of stratified medicine at Cancer Research UK. ‘This will allow us to build a database and understand if the presence of a certain marker means you do better or worse on a certain treatment.’
The programme will run for two years and, in that time, 9,000 patients across 20 hospitals in Britain will have samples taken from the six most common types of cancer: breast, bowel, lung, prostate, ovary and melanoma. The samples will be tested for a range of genes specifically linked to the progression of the cancer.
The hope is that this research will also provide a set of standards and processes for how genetic testing of tumours should be run in the NHS. It will also mean patients will be able to avoid debilitating side effects.
‘A lot of patients don’t respond to the cancer drugs they get and the only way we have of finding this out is to give them the drugs in the first place,’ says Peach. ‘Genetic testing might allow patients to avoid the painful and damaging effects of chemo or other treatments and give us a better understanding of the tumour itself.’
As well as benefiting patients, this could prove to be a cost-saving programme for the NHS as well.
‘The hope is the more knowledge we can build, the more we’ll be able to identify who will and won’t respond to different treatments,’ says Peach. ‘This will mean the NHS won’t be spending time or money administering treatments that don’t work.’
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