Revolutionizing cancer treatment with genomic testing

Thanks to advances in genomic testing, experts can now analyze hundreds of genes compared to just a few before, allowing them to more quickly and efficiently determine the right treatment for each individual patient. can now be specified.

Genomic testing allows clinicians to target specific mutations within tumors, leading to an increase in effective treatments and improved patient outcomes, said David L. Bartlett, MD. One of the new technologies he highlighted is liquid biopsy, which analyzes circulating tumor DNA in the blood, eliminating the need for invasive biopsies.

Bartlett, director of the Allegheny Health Network Cancer Institute in Pittsburgh, Pennsylvania, emphasized the impact of the increasing role of genomic testing in a variety of cancers, particularly lung cancer, where genomic testing is used to guide treatment decisions. However, this is not the only use of space genomic testing.

“Lung cancer is important, but we think colon cancer is also important. It also helps determine whether a patient will respond to immunotherapy,” Bartlett said in an interview with Targeted Oncology.^TM.

During the interview, Bartlett also explored the potential of next-generation sequencing (NGS), discussed ongoing research for cancer diagnosis and treatment, and discussed the use of genomic testing and its importance in cancer treatment. emphasized the increase in

Detection and screening of cancer as a treatment for malignant cells by biopsy or testing for cancerous cells as a symbol of immunotherapy, by testing due to carcinogens or genetics: © freshidea – Stock.adobe.com

Targeted Oncology: What are the benefits of genomic testing for cancer patients?

Bartlett: Genomic testing is basically looking at all the mutations that are present within the cancer. We biopsy the cancer and sequence the cancer to identify mutations associated with the cancer. This is very important so that these specific mutations can be targeted for treatment. Not all cancers have targeted therapies, but over time we will see more cancers develop mutation-specific targeted therapies. Knowing those mutations in advance is very important for us.

How has the approach to genomic testing changed over the years?

Over the years, [we have seen] There has been an explosion in our understanding of tumor genomics and what mutations exist within tumors. Whereas we used to search for panels of two or three mutations in tumors, we now routinely screen over 500 genes for known mutations that specifically impact cancer. I am.Amount of genetic material and number of mutations to be evaluated, as well as their efficiency [has improved]. The efficiency of the ability to analyze these mutations is increasing in time, as the original Cancer Genome Project and Human Genome Project took 13 years to create a single sequence, but now he can complete it in a day. It improved over time.

What are the recent advances in genomic testing?

We continue to make great advances in targeted therapies and identifying small molecules that can attack specific targets. More than 100 drugs are currently approved for specific mutations within cancer.There has been an explosion of information that the first drug approved was imatinib. [Gleevec] For targeted mutations, that was back in 2002.

Another concrete advance is the ability to identify circulating tumor DNA. By analyzing DNA in the blood, we can now analyze the same mutations that we analyze in tumors. We know that tumors release DNA into the blood, and blood tests can identify tumor mutations. That's a big advantage. There is a problem with having to do a biopsy, which can have a negative impact on the patient. It also makes it a little easier and faster to get the information you need through a liquid biopsy. The technology is evolving and we're still trying to understand a little more about whether liquid biopsies accurately reflect what's in a tumor biopsy, but in the future liquid biopsies will take over and what will happen. I believe you will be able to better express what is happening. Inside the tumor.

For what types of cancer are genomic tests most often used?

Many would say that for metastatic solid tumors, complete genomic profiling should be performed at the time of diagnosis. That way, they can look for all possible target mutations and make clinical trials available as new drugs emerge. But where it becomes most important is lung cancer. Lung cancer genomics defines whether treatment can be initiated for lung cancer patients. We need to get that information as soon as possible. As I said, it used to take a long time, but now he can get a complete profile of that patient in just two weeks. Basically, the patient is waiting for that profile before starting treatment.

Lung cancer is important, but colon cancer is also considered important. It can also help determine whether a patient will respond to immunotherapy. Because immunotherapy can be a game-changer for some patients, we want to know upfront if a patient is a candidate for immunotherapy. All cancers, but lung cancer is the most important at this time.

Can you explain NGS as a key tool for genomic testing?

Next-generation sequencing is what is currently being used to sequence tumors. This is simply a method that enables very high throughput and rapid and efficient sequencing of entire tumor genomes. This is a technique used for rapid sequencing of tumors to identify mutations.

Are there strategies for using NGS and its clinical applications?

I don't think a strategy has yet been established for what targeted gene mutation profiling is needed. For example, in certain types of tumors, there may be another drug that treats mutations in lung cancer better than it treats mutations in colon cancer, so there are several targets for different cancers. Consider whether you need a focused profile or just dosing. Is the profile of all known mutations in all cancers the same? It depends on cost, spending, reimbursement, and some complexities that may help determine how to do this in the future. It depends more or less on the factors. But what we hope will happen is that all patients with metastatic solid tumors undergo NGS sequencing to identify all known tumor mutations associated with their cancer. Doing so allows us to have the most complete information about every patient we treat and to share that information with new drugs, new clinical trials, and even existing immunotherapies and other treatments.

What challenges do you think need further consideration?

What we're interested in, especially when we're talking about liquid biopsies, is to look at how these mutations can be used to diagnose cancer. Diagnosis and screening using some type of NGS approach is therefore also an exciting aspect of the field moving forward. We know that tumors are constantly leaking DNA into the blood system, even in the early stages. So we're hoping to use NGS sequencing and use it as a screening method for cancer.[ing]Identifying cancer-specific mutations can not only determine whether a patient has cancer elsewhere in their body, but also potentially pinpoint which cancer it is for further testing. . It's really interesting to think about using these technologies to not only do early screening for cancer, but also to detect and track patients during cancer treatment and find out if they're responding to treatment. I think it will be.

Is there any other research underway in this or other areas?

There is a lot of interesting research on methods. [to make] How tests are becoming more sensitive to identify more mutations, and how we are looking at methods of DNA analysis other than just sequencing that can predict different aspects of cancer or the presence of cancer. Etc. There is a tremendous amount of exciting research that is likely to be developed in the near future that will help further orient us in terms of biomarkers in cancer.