For cancer patients and their families, navigating the pathway of patient care is challenging. Not only do many patients and caregivers enter the world of oncology with little awareness about their newly diagnosed condition, but they are also faced with difficult decisions on a daily basis. While most oncologists bring forward a high level of expertise and knowledge about their specialty, new medical advances in the field of oncology are happening every day. So, how can you make sure that you or your loved one is getting the best care for their condition? Furthermore, how can you discuss the latest new treatment options with your care team?
Let’s take a closer look at precision oncology, a rapidly evolving collection of diverse strategies in cancer medicine that is improving outcomes for patients.
As you can imagine, no two cancer diagnoses are the same. Two similar patients can be diagnosed with the same type and stage of cancer and still attain different outcomes. That’s because our genomic constitution is different from the next patient. Factors such as the environment you live in, the lifestyle you follow, your diet, other health issues, and your specific symptoms can weigh heavily on the effectiveness of your treatment and the long-term outcome of that plan. Testing the genetic and genomics makeup of your tumor, in particular, can provide medical professionals with actionable insights, such as, suggestions of more effective treatments, which may significantly improve the outcome.
In essence, Precision medicine tries to match the right drug to the right patient. Precision medicine is the next-generation healthcare that promises to provide a care package uniquely tailored to each individual's genomic makeup. Scientists believe that the more they understand a patient’s genomic profile, the better equipped they are to choose treatments which may lead to improved outcomes when compared with standard of care. Using the knowledge that your specific genomic profile may affect your response to certain medications, scientists and researchers can understand how you would react to particular drugs. What does this mean for you or your loved one? Oncologists can now create optimized treatment plans that maximize effectiveness and minimize adverse effects with drugs and drug combinations that are tailored to your unique genomic makeup.
The genomic information in each cell is coded by DNA (Deoxyribonucleic Acid) molecules which is the genetic material that contains the “code of life”. Cells transform this information into Proteins which are the key machines of your cells. DNA encoded information is constant across all cells of a single person. Tumor cells differ from normal cells in many ways, starting with alterations to the genetic information coded in their DNA. Tumor profiling allows scientists and oncologists to look at the genomic makeup of the tumor tissue sample. Since a portion of the DNA is used to encode for proteins, DNA alterations are likely to cause changes in proteins and their interactions, and a small number of drugs are known to interact with specific proteins, hence tumor DNA profiling can identify specific drugs that can fight the patient’s cancer. Unfortunately, the number of these drugs is relatively small. In addition, one of the other challenges posed by cancer tumors is that their genomic making, i.e. their DNA sequence, can change with time. This can lead to what is called treatment resistance, where the tumor cells try to fightback, and find new ways to keep on growing, thus reducing the effectiveness of treatment options previously identified based on the initial tumor genomic profile.
Overall, despite new hopes given by DNA molecular profiling, initial testing results using exclusively DNA profiles enabled selecting a therapy in only 5-25% of patients.
Enters RNA molecular profiling. Not widely known outside of the medical field, Ribonucleic acid (RNA) is a nucleic acid that’s present in all living cells. The main task of RNA is to translate genetic information stored in the DNA into proteins. Although all healthy cells share an identical DNA, their RNA expression is different, giving them their unique role. Indeed, a neuron cell from your brain, a cell from the retina behind your eye, or a cell from your muscle all share identical DNA but the difference in the RNA expression of specific genes makes them very different.
Measuring the levels of RNA enables to measure how much each gene is expressed. Therefore, looking at RNA in one cell is like only looking at the part of DNA which is actually used. In cancer cells, not only DNA encoded genes are altered, but the expression levels of RNA genes are also perturbated. A very large number of drugs are known to impact the expression level of specific RNAs. These drugs can be used to restore the expression levels of tumor cells back to normal levels. Hence, RNA molecular profiling has the ability to provide further insights and impact the choice of treatment for cancer.
While DNA testing alone presents limits, combining DNA and RNA testing has proven to be broaden therapeutic choices for patients and their families fighting cancer.
As with anything in the world of medicine, clinical trials have helped determine the effectiveness and outcomes of patients using precision oncology. So far, these trials have been dominated by platforms which investigate DNA structural abnormalities, and how they relate to treatment options, but a recent study has expanded to also includeRNA testing.
A study published on April 2019 in the journal NatureMedicine shows that profiling RNA, instead of DNA, allows more advanced cancer patients to benefit from personalized therapies, compared to standard DNA sequencing tests.
The goal of this study (the WINTHER trial) was to test the effectiveness of using DNA and RNA analysis for therapeutic decision. A total of 107 advanced multi-resistant metastatic patients (including 25% that had received and had been found to be resistant to five or more therapies) were biopsied and both DNA (using Foundation One™ panel) and RNA analysis were performed. If an actionable DNA alteration was identified, it was used for therapeutic decision. If not, RNA was used as a backup to provide a therapeutic recommendation for all remaining patients.
The study showed that in the context of the WINTHER trial, 40% of patients did not have a therapeutic recommendation using DNA profiling only, whereas with RNA profiling, a therapeutic recommendation could be provided for all patients.Due to the small sample size, the numbers were not statistically significant, however the study revealed that the overall survival of patients treated based on the RNA analysis was 45% higher than those treated based on the DNA
Overall the study demonstrated that the use of RNA expression can be used to effectively expand patients’ treatment options.
Moreover, it has also been demonstrated that patients who are treated with a drug or treatment plan that more closely matches the molecular profile of their tumor, do better when it comes to treatment outcomes.
The awareness of precision oncology is increasing exponential amongst oncologists and patients and OmiCure is helping translate this promise into reality for patients. Technological advances in DNA and RNA molecular profiling generates vast amounts of data and patients, oncologists and caregivers, need a simple tool that enables them to match patient’s data against ever growing scientific knowledge bases, and identify best therapies fora specific patient at a given time.
OmiCure provides a tool that streamlines and transforms this complexity into actionable results that can be easily comprehended by patients and oncologists around the world.
Here’s how it works. When a patient is diagnosed with cancer, their doctor takes a sample of the tumor(called a biopsy) and sends it to a biology laboratory to perform the genomic analysis. The data corresponding to the sequencing of the DNA and/or RNA of your tumor is sent to OmiCure. They use Artificial Intelligence to analyze your unique genomic and/or transcriptional profile and compare it with international knowledge bases of drug-gene interactions. Insight from medical experts, other patients, clinical trials, and published data are compared to develop a patient-specific report ranking the best potential treatment therapies for you.
Thanks to the addition of RNA profiling, more patients have been matched to treatment options than were possible with DNA only analysis. Thanks to this technology, oncologists have rapid access to information on the most effective cancer therapy to fight your tumor in a constantly evolving medical world. Precision oncology using RNA molecular profiling is revolutionizing cancer treatment, helping doctors choose the right treatment for the right patient with confidence. And it also helps patients avoid unnecessary side effects and decrease the cost of treatment, as a bonus.
Hearing a doctor say that you or your loved one has cancer is, undoubtedly, a life-changing, scary event. Navigating your treatment options, understanding your choices, and being equipped with the wealth of knowledge you need to advocate for yourself or your family is overwhelming. This is especially true when doctors provide multiple options that need to be discussed with you.
For patients, caregivers, and medical professionals, precision oncology is the answer to the many questions that still exist when faced with a cancer diagnosis. Luckily, RNA molecular profiling provides the next step to more effective cancer treatment and informed patient care. It is truly bridging the gap of DNA-only precision oncology to improve outcomes for cancer patients worldwide - a much-needed step in the right direction to confront the untamed beast that cancer is.
