Therefore, at the IV National Symposium on Applied Genomics in Oncology, held on Tuesday, March 20 at the National Center for Oncological Research (CNIO), national and international experts gathered there insisted on the importance of each and every cancer patient being entitled to know the genetic map of his/her tumor, which would imply universal access to genomic sequencing platforms for the diagnosis and treatment of cancer.
In the opinion of Dr. Enrique Grande, head of the Medical Oncology Service at MD Anderson Madrid – Hospiten, and Dr. Jaume Capdevila, of the Gastrointestinal and Endocrine Tumors Unit at the University Hospital of Vall d'Hebron and of the research group of the same name at VHIO, co-organizers of the Symposium, the study and knowledge of these molecular alterations can be useful, not only at the beginning to identify the origin of the tumor, but also later in the analysis of changes in the routes of growth of the tumor, since these are changes that condition resistance to drugs in the treatment of metastatic tumors.
Access to the new genetic platforms, a luxury or a right?
The opportunity to access genomic sequencing platforms allows health professionals to know the molecular alterations that originate and maintain the growth of a tumor, thus providing them with a complete map of the tumor. This general view of the tumor at the molecular level is very vital because it allows more molecular targets on which to act pharmacologically to be identified. Thus, if a patient stops responding to a first drug, the map helps the oncologist to identify thebest possible therapeutic target to continue acting in the second line of treatment.
For this reason, genomic platforms should be a right for the patient, "a luxury is something accessory, the lack of which is of little or no importance, and a right is something necessary - today, all patients should have access to knowledge of the molecular biology of their tumor", Dr. Grande insists. "Molecular alterations are not only important when choosing a treatment, but have a direct impact on the prognosis of the initial tumors that we operate on," concludes the doctor.
Dr. Capdevila also wanted to emphasize that knowledge of genomic alterations is essential to the advancement of personalized medicine. Without this advance in the application of disciplines related to the study of genomes, "personalized medicine will never be possible, because it needs better knowledge of the biology of the tumor and of the biology involved in the entire tumor niche", says Dr. Capdevila. Furthermore, he continues, "all this demands a breakthrough in technology so that this knowledge may be applied”.
Epigenetic drugs, one of the main research channels
Another of relevant aspect highlighted at the meeting was the research on epigenetic drugs that, although very promising, still seem to be far from having an impact on real clinical practice. Epigenetics is a part of the rise in molecular biology, which consists of the study of molecular alterations that may or may not affect the expression of certain genes. Thus, for example, a person may have an altered and apparently inactive gene that began to express itself after the activation or inhibition of another gene.
Research in epigenetic drugs is in full development, but is complicated given that its activity does not directly impact on the "altered" gene, but indirectly on another gene. "It is very difficult, with current technology, to understand what impact these epigenetic alterations have on the behavior and biology of the tumor," says Dr. Capdevila, a statement with which Dr. Grande agrees, saying that "there is a little science fiction involved and going beyond the disease itself, as we are investigating treatments that control genes which, in turn, can control other genes". The challenge now is to be able to incorporate these epigenetic markers into clinical practice for use in making diagnostic and treatment decisions in oncology.
Molecular Tumor Board Meetings
MD Anderson Madrid – Hospiten is leading the molecular biology applied in oncology. Proof of this is the launching of specific Tumor Boards, that is, multidisciplinary molecular diagnosis sessions. In these meetings, the approach to patients with complex tumors, which demand techniques and unconventional molecular platforms is discussed. "We try to implement all these platforms in the context of a multidisciplinary task - the patient and the disease demand it", points out Dr. Juan Fernando García, head of the Pathology Service at MD Anderson Madrid – Hospiten, who emphasizes that "what we are seeking is to implement platforms more efficiently in the context of a joint task between different professionals".
"The use of genomics can be applied to any tumor, either solid or hematological, although it is true that it is more established in breast, lung and colon cancer and although simple techniques are used," says Dr. Garcia. If we talk about more complex techniques, the so-called next-generation sequencing techniques (NGS), the situation changes, as these techniques, however, are not standardized. Compared with simpler techniques, NGS techniques allow the identification of more alterations than usual, which means that the patient has the opportunity to know the tumor more deeply from the molecular point of view and, therefore, the possible routes of action on different therapeutic targets.
During the meeting a special reflection was made on how to choose a molecular platform to estimate the risk of a patient with breast cancer. In this sense, Dr. Laura Garcia Estevez, head of the Breast Tumor Section of the Medical Oncology Service at MD Anderson Madrid – Hospiten, states that "not all patients with hormone-sensitive breast cancer will benefit from chemotherapy treatment. For many years, oncologists have used clinical-pathological factors to evaluate the need for chemotherapy treatment". Today, she continues, "we have different genomic platforms which, although different, mostly give prognostic information about the tumor".