Kuveda helps oncologists in providing effective personalized therapeutic cancer treatment options. At Kuveda, we believe that every patient’s cancer diagnosis is unique and cancer therapeutics will now be delivered on a personalized basis enhancing patient’s quality of life and survival rate.
The American Society of Clinical Oncologists (ASCO) has identified “Panomics” as one of the “drivers of change” that will have the greatest effect on the field of oncology. Panomics is a subspecialty of the larger field of Personalized Medicine and is defined as the understanding of the complex combination of genes, proteins, molecular pathways, and unique patient characteristics that together drive the disease of cancer, as well as an understanding of how to target these factors in combination to develop prevention strategies and curative therapies.
With the advent of panomics, oncologists and their patients now have access to a new tool in the fight against cancer known as molecular profiling. A molecular profile is derived from a patient’s tumor biopsy through the use of protein and/or genetic testing. Using the findings from these tests a highly refined molecular profile of your unique cancer is then created which can be used to help define potential treatment options.
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Conventional thinking has long associated cancer with its anatomical site of origin (i.e., breast cancer, lung cancer, ovarian cancer, etc.). However, with recent advances in molecular biology, genomics and panomics it has become clear that the mechanisms at the core of cancer are molecular in nature and subsequently unique to each and every patient .
With recent advancements in molecular biology, it is now possible to uniquely identify specific genetic and molecular variations of a patient’s individual tumor. Known as a tumor profile, this profile can be used as the basis to formulate treatment plans that target the molecular structures that may be driving an individual patient's unique cancer.
“Precision medicine”, also referred to as “Personalized Medicine”, is the application of panomic analysis and systems biology to analyze the cause of an individual patient's disease at the molecular level and then to utilize targeted treatments (possibly in combination) to address that individual patient's disease process. The branch of precision medicine that addresses cancer is referred to as "precision oncology".
The term “biomarker” refers to numerous different compounds that may infer something about your health. Biomarkers have been identified for many diseases. When associated with cancer, biomarkers generally refer to genes, proteins or other molecules that affect how cancer cells grow, multiply, die or respond to other compounds. Biomarkers are now becoming a key tool in cancer diagnosis and treatment strategies. The anatomical site of origin of cancer is being replaced with a more precise diagnosis that details the specific description of patient’s identified cancer biomarkers including any associated genetic mutations.
These biomarkers have shown that the notion of defining a cancer by anatomic site of origin is a too simplistic view. Further, research now demonstrates that an individual’s specific biomarker may present itself across various tissue type body parts. Consequently, treatments previously found to be effective and suggested for one particular tissue type body part may have potential benefit for a specific patient on a tumor associated with a different tissue body part. In short, the molecular profile and the associated treatment options for that profile can be more relevant than treatment options that are tissue type specific.
As we asserted, in the section Cancer Biomarkers, biomarkers come in various flavors – including genes, proteins and specific molecules. Why are they important? Cancer is a disease of the DNA, the substance within each and every cell that controls and directs all cell activity. A person’s genome (DNA) is made up of sub units known as genes. These genes are the biological code for the construction of proteins and proteins are the micro-engines that perform all cell related activity. A mutation is an error in the gene code. Sometimes the mutation will cause the gene to be unable to encode for a protein. However, in some cases the protein is still constructed, but it is distorted somehow or it distorts something else in the system. Its intended cell related activity or structure has now been altered.
It is commonly known that some people are born with mutations that can predispose them to cancer. However, most cancer cases are a result of numerous mutations that build up in our cells over the course of our lives. As disheartening as this may be, mutations are a rather commonplace occurrence. In fact, our bodies produce proteins within our cells whose function is to identify and repair these mutations or to initiate a process know as apoptosis (programmed cell death). Killing off the cell before it can multiply and propagate its mutations. Unfortunately, when mutations build up in the genes that regulate the rate of cell growth or in the genes that code for the proteins that safeguard our cells through repair or apoptosis we are no longer protected and cancer may ensue.
Part of protein activities includes the ability to communicate messages with other proteins. The communication paths that the proteins use are called signaling pathways. As an example, the growth of a cell is triggered by a signal on the outside of the cell causing a growth factor membrane receptor to be activated and initiating a message which travels through the membrane into the cell, along various signaling pathways and eventually into the cell nucleus where a new protein is synthesized to effect growth. Mutations can adversely affect this communication path anywhere along the path possibly resulting in uncontrolled growth.
Understanding of signaling pathways, protein function and genes have enabled pharmacologist to develop drug therapies that target the communication pathways of cells. For example, in some cases these drugs disrupt a communication path to interfere with specific molecules that contribute to tumor growth and progression. In other cases these drugs may stimulate a communication path to enhance or jump-start an immune system response to destroy specific cancer cells.
Identifying cancer biomarkers can be accomplished with a series of testing methodologies known as Molecular Profiling. Cancer biomarkers can be found in genes, proteins and specific molecules. Various tests have been devised to identify and measure these markers.
Generally, these tests can be run from tissue samples taken during a patient’s biopsy.
Armed with pathway and protein understanding researches can design highly targeted drug therapies. Unlike standard chemotherapy, targeted therapies are designed to interact with specific molecules that are part of the pathways and processes used by cancer cells to grow, divide, and spread throughout the body. Targets are chosen very carefully. When researchers discover a potentially vulnerable molecule involved in a cancer process or pathway, new therapies can be developed to disrupt its activity with great precision.
Molecular profiling can assist oncologists by identifying which drug treatments are best suited for a patients particular molecular abnormalities resulting in a much more focused treatment regiment. Just as importantly, molecular profiling can highlight which drugs have no chance of working with a particular patient. Armed with this information oncologists can save valuable time, money and anxiety by eliminating these drug options from a patients regiment right up front.
There are a variety of targeted drug approaches that act to block cancer growth or improve the body's ability to fight cancer, including small molecule inhibitors, monoclonal antibodies, vaccines, and gene-expressing plasmids. One of the best-known examples is the drug trastuzumab (Herceptin®), which is a monoclonal antibody developed for breast cancer. This drug was designed to specifically inhibit a single protein, the HER2 receptor, which may be amplified in some women with breast cancer. In this group of women, this treatment has dramatically changed the course of their disease, lengthening their lives and improving their quality of life. There are a number of other personalized medicines that are becoming standard in cancer treatment, including imatinib (Gleevec®), erlotinib (Tarceva®) and newly approved medicines like crizotinib (Xalkori®) for lung cancer and vburafanib (Zelboraf™) for melanoma.
The techniques associated with applying molecular profiling on patients is still early. The vast majority of cancer patients today are still treated using the principles of anatomic site of origin and its associated standard of care therapies. Further, the level of expertise and experience of medical professionals to effectively apply molecular profiling techniques are still limited to the most advanced clinical cancer institutions. And even within these institutions it is a somewhat choppy application from institution to institution.
Nearly all cancer patients today will initially undergo the traditional standard of care regiment (which uses little to no molecular profiling). And for many patients these regiments will show significant promise. Though success rates vary quite widely based on anatomic site origin and the associated conventional treatments. Taken, as a whole standard conventional treatment is currently successful for about 76% of the cancer population (measured as no discernable relapse for a period of 5 years). Unfortunately, studies estimate that if standard of care treatments fail or a patient relapses as few as 5% of cancer patients will respond to the next treatment suggested by conventional methods.
However, two recent cancer studies show that treatment regiments based on biomarker testing coupled with molecular tumor profiling have shown promising results.
One recent multicenter study in the Journal of Clinical Oncology showed that, even in patients with late-stage cancer, many of who had exhausted all conventional therapies; molecular profiling increased progression-free survival from various cancers in 27% of the 86 patients they studied. A reference to an abstract of this study is provided below:
Many of the sites below were used as direct sources for the material presented. We strongly urge you to review the sites listed below for further information on understanding your cancer.Patient Specific Cancer Web Sites - Easy to Read, Easy to Understand
|Why Kuveda||Paradigm Shift in Clinical Practice in Oncology|
|Cancer Biomarkers||Leading Cancer Centers Opting to Practice Molecular Profile Based Therapy|
|Mutations and Signaling Pathways in My Tumor Cell||Kuveda is on Your Side|
|Every Cancer Patient is Unique|
|Does Molecular Profiling Really Work?|
|Patient Specific Websites|