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Cancer Research UK to Launch Pilot Project on Personalized Cancer Therapy

Posted Jun 04 2010 12:00am
You will discover various definitions for personalized medicine in a web search. I prefer the term targeted therapy because "personalized" is often misunderstood by healthcare consumers to refer to their personal preferences for services. In my view, personalized medicine usually refers to the treatment of cancer. In this same context, the basic idea is to identify the genetic characteristics of a malignant lesion and then attempt to tailor the treatment of it in a manner that eradicates the tumor without unduly harming the patient. This has largely been a theoretical construct in healthcare delivery despite the wide use of biotech drugs because of the genomic complexity of cancer cells. We are now moving in a more practical direction. As one example, the non-profit Cancer Research UK is launching a large-scale trial of personalized cancer therapy involving 6,000 patients (see: Gene test hope for personalised cancer therapy ).
NHS patients are to be offered personalised cancer treatment under a pilot scheme to carry out genetic tests on individuals' tumours. C ancer Research UK hope that the project will analyse the tumours of up to 6,000 patients a year for a range of genetic defects. The results will guide doctors in choosing the most effective therapy for that patient.The charity predicts such tests could become routine within five years. Due to be launched in the autumn, the project will examine how best to roll out genetic testing across the NHS. Six centres will be set up around the country where scientists will classify a patient's tumour according to the specific genetic mutations it carries. Patients will have their tumours genetically tested, and will receive treatments based on the evidence of what does and doesn't work for their type of tumour, Patients will then be offered drug treatment based on the genetic make-up of their cancer. Potentially, such an approach could save the NHS money by cutting prescribing of expensive treatments which are unlikely to work. Harpal Kumar, chief executive of Cancer Research UK, said scientists have now discovered enough genetic markers and drugs for such testing to make a real difference. Cancer drugs which have been developed in recent years to specifically target a genetic mutation, include the breast cancer treatment Herceptin. Some genetic testing is already done in NHS cancer patients, but provision is patchy and tumours are often tested for just one mutation.

First of all, let me say that such organized projects are long overdue. Personalized medicine is one of the most misused terms in the healthcare lexicon. Every press release from a lab offering molecular diagnostics uses the term endlessly. The article above gets the process right. First, analyze the lesions for "genetic mutations" using a small set of labs operating under a uniform set of guidelines. Next, select the most appropriate therapy for the enrolled patients based on the lab results. For me, the sole misstep in the article above is the statement that the approach "could save the NHS (National Health Service) money." Can anyone recall a scenario where the deployment of new technology was less expensive? Let's face it. The cost of molecular diagnostics will be more expensive than previous lab testing and the biotech drugs selected will also be more expensive than previous therapy.

I assume that an integrated clinical database will be developed across the various participating hospitals and labs. This database can then be used to determine the most effective therapy for a particular lesion. In addition, I hope that this integrated database will contain whole-slide digital images of all of the primary lesions and autopsy material. Ideally, some of these images will be post-treatment to assess the morphological effects of the various drugs. We are also about to enter an era in which it's possible to select a histological field of interest for a malignant lesion and then ask the  following question: which therapeutic regimen was the most effective for patients with a similar lesion (see: Technologies and Tools to Search Images with Image s; Digital Pathology vs. Digital Radiology: A Broad Divide ).

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