Precision oncology is a novel approach that aims to reverse cancer resistance and transform patient outcomes. Given the rising incidence of cancer cases in Asia, innovations within precision oncology is paramount in tackling the region's cancer burden. This article explores the benefits of precision oncology in comparison to traditional therapies, and the way forward for this promising space.
The global burden of cancer is increasing at an alarming rate. Cancer is the second leading cause of death globally, accounting for over 9.6 million deaths, or one in six deaths in 2018. Lung, prostate, colorectal, stomach, and liver cancer are the most widespread forms of cancer in men, whereas breast, colorectal, lung, cervical and thyroid cancer are the most frequent among women. It is predicted that by 2030, there will be nearly 26 million new cancer cases and 17 million cancer deaths each year. Some of the contributing factors to this rise include increasingly ageing populations as well as shifts in the prevalence and spreading of key risk factors of cancer such as harmful lifestyle changes and environmental exposures.
Asia accounts for nearly half the global burden of cancer. Moreover, the incidence of cancer cases is estimated to reach 10.6 million in 2030. There are 3.6 million males and 4 million females battling cancer in Asian countries. In South-Eastern and Eastern Asia, infection-related cancers such as liver and stomach cancers remain among the most diagnosed cancers and top causes of cancer death among males. Cancer prevalence has also been growing within the female population, with Korea, Japan and Kuwait showing the most substantial rise in the past decade. In 2020, there were nearly 159,000 new cases of breast cancer in Southeast Asia alone. A lack of awareness may increase the cancer burden over and above the current estimates.
Along with this, most cancer treatment modalities, barring a few exceptions, are not efficacious in curing the disease. Once the disease is widespread (metastatic), more often than not, all we can do is offer palliative care. Moreover, the ongoing financial burden borne by cancer patients and their families takes a huge emotional, mental, and physical toll. A cancer diagnosis can rapidly bring about catastrophic expenses for a household, where a disproportionate amount of income is spent on cancer treatment. Moreover, patients may not be able to continue working due to their symptoms, treatment, and/or side-effects, leading to weaker economic conditions. A recent study has shown that there is a significant prevalence of anxiety and depression among patients suffering from various types of cancers in Southeast Asia.
There are several methods for treating cancer, depending on the cancer type and stage, and the desired patient outcomes. For example, if a cure is not available, the patient’s treatment regime is largely focused on shrinking the cancer or slowing the growth of the cancer cells to allow the patient to live symptom-free for as long as possible. There are local treatments such as surgery and radiation therapy, which are used to treat a specific tumour or area of the body. Meanwhile, systemic treatments like chemotherapy can affect the entire body. However, these traditional therapeutic approaches have their own significant share of challenges. The side-effects and longterm consequences of chemotherapy remain major causes of concern for both patients and doctors. Gastrointestinal side-effects are common and can be both troubling and potentially even fatal for some patients. In addition, radiation therapy not only kills or reduces the growth of cancer cells but can also harms adjacent healthy cells. Some common possible side-effects of radiation therapy include dry mouth, fatigue, loss of appetite, hair loss, nausea, and vomiting. Both chemotherapy and radiation therapy, even when effective, increase the risk of secondary cancers developing some years after the first cancer due to the damage caused by the treatment itself. The complexity of cancer treatment is increased by the fact that cancer cells can develop resistance to traditional therapies, leading to a rise in drug-resistant types which necessitate further research and development to discover novel therapies.
Though modern medicine has achieved important milestones, there are still many concerns that need to be addressed to improve cancer therapy. In this direction, research in oncology continuously endeavours to find new, advanced, and efficient treatments which can reduce the serious side-effects and drug resistance triggered by conventional treatments. Doctors are switching from generalised, one-size-fits-all therapies to tailored treatments and disease interventions. One such innovation is precision oncology. Cancer development can vary from patient to patient and this form of treatment is exclusively designed and directed towards a patient’s unique cancer characteristics.
While genetic variations impact our physical characteristics such as height and hair colour, they also influence the probability of getting certain diseases like cancer. Some genetic variations shield us from certain diseases, while others make us more prone to diseases. Tumours have genetic variations that affect the growth and spread of cancer. These changes are different for different people. Precision oncology uses each patient’s distinct genetic profile to diagnose cancer, create personalised treatment plans, monitor the response to treatment, or make a prognosis. Examples of precision medicine consist of targeted therapies that are used to treat certain types of cancer cells, like HER2-positive breast cancer cells or be utilised for tumour marker or biomarker testing to help in the diagnosis of cancer. Precision oncology holds the promise of better efficiency, improved care, and reduction of treatment costs. Currently, it is still in the nascent stages of development for the treatment of several cancers.
Due to the heterogeneity of the disease, standard cancer treatments such as radiotherapy or chemotherapy are efficacious only in certain subsets of patients. Well-designed and accurate cancer treatments like precision oncology can give patients and physicians the opportunity for better therapy selection and improve treatment success rates, thereby increasing the chances of survival. These therapies also result in reduced exposure to ineffective drugs and their negative side-effects.
While conventional treatment like chemotherapy kills cancer cells by generally “poisoning” the cells’ metabolic processes, targeted therapies treat cancer by blocking specific proteins that facilitate the growth and spread of malignant tumours. Precision therapeutics builds upon a better understanding of the fundamental mechanisms of the occurrence of various diseases and also offers an improved capacity to identify which treatments will yield positive results for certain patients. Moreover, precision treatment is less harmful to healthy cells and generally has more tolerable side-effects in patients as compared to traditional cancer treatments like chemotherapy. The ultimate goal of this treatment is to recognise and provide the ideal therapy for patients to boost their chances of survival and improve their quality of life. There have been multiple stories of success exhibiting the potential of targeted therapy in precision oncology. For example, when patients with breast cancer, metastatic gastric adenocarcinoma, and salivary ductal adenocarcinoma with HER2 magnification are given the combination of trastuzumab (monoclonal antibody) with chemotherapy, it has shown improved clinical results compared to chemotherapy alone. Precision oncology is therefore bringing about a paradigm shift in the treatment approach of doctors treating cancer patients.
In this regard, biotechnology firms like AUM Biosciences are pushing new frontiers in the field of precision oncology by developing a pipeline of therapeutics designed to overturn cancer resistance through multi-faceted inhibition strategies. They have cited optimistic results of their cancer drug, AUM001, a mitogen-activated protein kinaseinteracting kinases (MNK) inhibitor. It has completed two Phase I trials and has demonstrated good safety, tolerability, and target engagement. A global phase II trial has been initiated for patients with colorectal cancer. Among the different roles in the body, MNKs are also involved in tumorigenesis. Inhibition of MNKs is a newer area of precision medicine acting at the chokepoint of selective translation inhibition (where RNA messages are converted to proteins) in cells. This allows AUM001 to potentially overcome drug resistance in the cancer cells, as well as having the ability to target “undruggable” pathways.
Novel trial designs have also been adopted to identify patients who are most likely to benefit from a treatment, thereby reducing drug development time and costs. As the role of biomarkers in the early detection and monitoring of cancers as well as the development of cancer therapeutics is important, biotech companies such as AUM also mandate use of biomarkers to enhance patient selection and conduct trials to increase the prospect of success over conventional approaches.
Over the last decade, there has been continuous progress in the field of precision oncology across multiple tumour histology and biomarker-based trials. However, some critical challenges persist. Since precision oncology is a
growing field, many of the technologies that are necessary to meet the goals have only recently been developed. For example, databases are needed to store large amounts of patient data efficiently. Cost is also a concern with precision oncology. Clinical trials of precision oncology require millions of dollars of funding over several years. Technologies like DNA sequencing, which are an integral part of the research, are expensive to carry out. It is vital that the potential participants get a holistic idea of the risks and benefits of participating in this research. There is also a need to promote inclusivity to overcome the inherent limitations in current studies which primarily include the western or European population. Since these modern therapeutics are based on patient data, there is a growing concern about ethical, social, and legal issues. Additionally, standardisation and harmonisation of the collected clinical and genomic data and its accurate interpretation to enable best practices remains a challenge. Moreover, according to a report, 70 per cent of oncologists agree that precision oncology is promising, while 29 per cent admit that it is still not widely applied in their daily practice.
Additionally, there is also the problem of providing sufficient evidence of safety and efficacy which hinders approval processes. Regulators struggle to accommodate new innovations in this field due to smaller trial designs which create statistical complications in terms of understanding a drug’s risk-benefit profile.
Researchers are continuously trying to make the latest and the best cancer treatments more accessible to patients. Precision oncology has the potential to become one of the most successful therapies for cancer and much progress has been made in this field. However, transforming cancer care with precision medicine remains a major challenge due to still-evolving technology, specific infrastructural requirements, need for extensive and standardised database development, lack of inclusive trial data and significant financial implications.
Precision oncology can bring groundbreaking changes in cancer treatment and transform the approval process for new therapeutics. This coupled with the introduction of molecular data in electronic health records will improve the timeliness of patient screening and treatment, thereby improving their health outcomes. With collaboration among the various stakeholders such as clinical, diagnostic, pharmaceutical and academic communities, we can dream of living in a world where cutting-edge cancer treatments are accessible to all.
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