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By Jesse I. Spector, M.D.
Some of the discoveries that have come to the forefront with new treatments of cancer include blood tests that can help determine which patients are most likely to benefit from specific treatments. Additionally, blood tests now available give us information before treatment is even begun as to what we might expect of the treatment.
Nowhere has this become more important than with the research on breast cancer and the information that has been derived within the past five to 10 years on tests on the breast tissue obtained at the time that the diagnosis is made. This subsequently gives us insight into what we can expect from our treatments in terms of the potential for cure, or if not cure, than at least for the possibility of longer term survival even before we actually determine the treatment or initiate the therapy.
The tests that are available cover a gamut of laboratory approaches. In breast cancer for instance, the information derived from the breast biopsy falls into a number of categories including tests for DNA study of the cancer cells, a genetic type of evaluation, as well as determination of various receptors on the breast cancer cells that help determine whether specific hormone therapies may or may not be of benefit. Additional information derived from the breast biopsies can be analyzed and are now routinely studied for a receptor called HER-2, which is found in about 20% of women with breast cancer. The presence of HER-2 can determine whether a biologic treatment directed at the target HER-2 receptor will be of a potential benefit in killing the cancer cells. This newer approach of biologically-directed treatment with regard to non-chemotherapy type treatments targeted specifically towards malignant cells has now been FDA approved in lung cancer, colon cancer, and breast cancer among others. Lymphoma is another area of increasing use of these targeted types of non-chemotherapy treatments.
These newer approaches may be help patients avoid the more old fashioned type of “shotgun approach,” where a certain drug, particularly a chemotherapy drug, is used because it is generally felt to be beneficial for a certain type of malignancy, but from our experience will only work in a certain percentage of these patients. If we can determine which patients would or would not benefit from the specific treatment, we can tailor the treatment to only those patients, and avoid using an ineffective drug that may have many side effects in other patients.
We are always finding limitations of chemotherapy-type treatments. Therefore, the fact that we now have a different venue with biological-type treatments directed more towards a specific cancer means we can offer a more custom-tailored approach to treating a malignancy. We can make individualized treatment decisions, rather than take an “off the shelf” treatment program and apply it to all patients with a certain type of cancer. I believe that this approach not only now has proven itself to be realistic, but as many of the experts in the field of cancer predict, within a not unreasonable number of years will allow for almost all patients, an individualized approach in treatment decisions to deal with their specific cancer problem.
One additional point is the prognostic information that we can derive from the testing done on cancer tissue when the diagnosis is first made. We now are aware that there are certain genetic abnormalities that we can test for with a variety of malignancies that give us information up front as to what the long term outlook will be and whether a condition is curable, treatable, or if it will be very resistant to treatment. This type of genetic study is becoming common with a variety of blood malignancies such as leukemia, and in the near future, will have application to what we call solid tumors, i.e. those malignancies such as colon cancer, lung cancer, breast cancer, etc., which involve various organs of the body rather than involving the bone marrow and the blood stream. Having this type of information can help the physician determine a treatment plan so that those patients whose prognostic tests indicate a very good outlook may be given potentially much milder treatment than a patient whose prognostic information indicates a more aggressive tumor that requires more aggressive therapy with heavier types of treatment since anything less than an aggressive approach will not do the job.
Ten years ago, the information in this article would have seemed out of the question and more like "Star Wars." Now, over a relatively brief period of time, we see advances that have great potential in terms of application for clinical practice that may within the next five to 10 years have a significant impact on patient tolerance and better outcomes with regard to treating various cancers
Dr. Jesse I. Spector is a hematologist/oncologist at Berkshire Hematology Oncology Associates in Pittsfield. He is a practicing clinical oncologist and also actively involved in numerous researching studies for various forms of cancer.