by Dr. Rekha Harting, with contribution by Dr. Patricia Madej
The concept of personalized oncology recognizes that cancer is a different process in every single individual; no two individuals are alike and no two cancers — even if they have the same name, diagnosis, or stage — behave the same way. Our approach to personalized oncology at the AMITA Health Cancer Institute operates on three fronts. First, we look at the characteristics of the disease itself: tumor size, histologic type, extent of disease, nodal involvement, and the presence or absence of metastases.
Second, we look at the molecular profile of cancers, at the genomic level, to identify specific qualities of the tumor that will help us direct treatment. In breast cancer, the presence of estrogen or progesterone receptors or amplification of the growth factor receptor HER2 can signal responsiveness to a particular treatment regimen. New treatments now target the intracellular molecular mechanisms of cancer growth and survival with drugs that alter metabolic pathways and protein amplification pathways. For example, we can detect the presence of epidermal growth factor receptor, EGFR, or targets for cell cycle checkpoint inhibitors, such as PDL1, that can limit tumor growth. Tyrosine kinase inhibitors that interfere with tumor cell biology are now used to treat many types of cancer, including kidney cancer, lung cancer, melanomas, colon cancers, and breast cancers. CDK4-6 inhibitors have been used to halt the growth of certain types of breast cancer cells. A checkpoint inhibitor targeted to PD-L1 can unmask the immune system and stimulate an immune response directed at tumor cells.
For any patient with any cancer, we start with a fairly extensive set of studies to molecularly characterize the cancer and identify the targeted therapies to which that tumor will respond. Certain markers and tests are unique to specific types of cancer, while other types of cancer may not (yet) have any commonly identified molecular or genetic markers. Still other cancers may express a known marker that signals responsiveness to a particular therapy, but patients will require further treatment; in these cases, we can send off tumor tissue for extended genomic testing of more than 300 genes. Some of these genes are targets for approved therapeutics, while the presence of other genes may make a patient eligible for ongoing clinical trials of investigational therapeutics. For all patients, but particularly those who are not responding well to conventional therapy, we search for any clinical trial opportunities at the local, national, and international level.
The third aspect of personalized oncology at AMITA Health is our approach to the whole patient, beyond the cancer itself. We take into account psychosocial and emotional factors, other medical problems, the patient’s support system, financial issues, and treatment goals and expectations. Evaluations and treatment recommendations synthesize these factors — all of which can affect response to treatment. Our nurse navigators are critical partners in helping us understand these patient-related factors so we can better tailor care to meet each patient’s needs, including providing symptom relief, 24/7 access to a nurse or physician, access to support groups and services through AMITA Health Cancer Institute and Wellness House Hinsdale. Patients also have an opportunity to schedule a consultation with our Integrative Oncology program specialist who helps patients incorporate alternative or complementary methods into “conventional” treatments without harm or risk of impeding the conventional cancer treatment.