The concept of agnostic tumor suppresses one step more precisely the oncology of precision, with therapies directed directly to the genetic alterations that cause the tumor, Independently of its localization.
This year, our medicine has taught us many lessons. One of them is the importance of a good diagnostic. Writing tests and different ones to detect a sickness are essential to the prevention of a lot of illnesses, but also
when it comes to deciding what will be the best treatment for a patient. Cover with special import in case of cancer.
Although the cancer has been converted into many cases in one enfermedad curable y and otros, preventable (following OMS, the 30% of deaths due to cancer can prevent the occurrence of risk factors such as tobacco, malnutrition and sedentary life), is a disease that results in many inconveniences about their behavior.
Decades of investigation have opened the truck of one of the last worth of treatments, the agnostic approach to cancer. The most advanced ADN sequencing techniques have made it possible more deep genetic study, favoring the discovery of genetic alterations (or biomarkers) responsible for certain types of cancer. It is the ultimate piece of information available and allowed direct the treatment of tumors by taking into account the genetic characteristics of the tumor, more about its location and stadium. It’s what is known as
precision medicine.
To the doctor Rosario García Campelo, head of the Oncology Service at the CHUAC and in charge of the Oncology Group at the INIBIC research center, in A Coruña, the main innovation of the last years has been, since then, the “Genome characterization of cancer. There is a dissection that hemosphere of the distant tumors, there is not only one lung cancer, but that
we know various subgroups based on genetic alteration determinations that he allowed a personalized abortion ”.
Pulmonary cancer is the best example of understanding the concept of precision medicine, according to Doctor Garcia. “Empezamos in the year 2004 with an authentic Biomarket revolution with the discovery of EGFR gene mutations and since then the list has not been created ”. Some, like the NTRK gene, exemplify it to perfection: “it has been described in very few tumors as pediatric tumors and very frequent tumors such as pulmonary cancer”. There are currently more than 700 biomarkets and studios.
- Wear. Rosarío García
- Wear. Lara Pijuán
- Wear. Lara Pijuán
Pulmonary cancer is the second most frequent in the world, with more than 2 million cases each year. In Spain it was diagnosed near 30,000 new cases each year, according to the Spanish Society of Medical Oncology. It is, in addition, the most deadly type of cancer, since responsible for a 20% of the total deaths per cancer. But, on the other hand, it is also one of the nurses in which he has made the most advances in recent years, and he has made great progress in the reduction of mortality, diagnostic techniques and new treatments.
There are two classifications for pulmonary cancer: small cells (microcytic) and large cells (no microcidal). The first representing a 15% of cases, without embarrassment, is the most aggressive and it is detected in stages of the disease, with metastasis. The research and genetic engineering of this type of tumor has allowed us to obtain new drugs and therapies and “It has radically changed the way we treat cancer and the whole way we treat our patients”, apunta la oncóloga.
Precision medicine
The success of the precision medicine, which allowed the specialists to saber what treatments are performed on the patient as a result of the genetic dissection of his or her illness, depends enormously on the diagnostic. “We will diagnose the cancer now that we will not have anything we want to do for years. In terms of the ‘number’ that the demos have a tumor that enhances genetic studies and looks for molecular alterations “, explains doctor Lara Pijuan Andújar, pathologist at the Hospital del Mar, in Barcelona.
Molecular alterations are what define the concept of agnostic tumor: genetic alterations that are responsible for generating the disease, but
“Pueden can be presented in distinct organs and can be treated with homogeneous form”, determines the doctor García. That is, with direct therapy exclusively to our biomarkers, to cancer cells, do not affect anything more. For this reason it is now very important give to cancer number and appeals, affirms the doctor Pijuán: “It is not the same thing to tell a patient that he has a carcinoma and that he has an adenocarcinoma”.
A good diagnostic, better treatment
It is estimated that in turn a 30% of patients with pulmonary cancer may benefit from these guided therapiesHowever, in order for these treatments to be read all over the world, access to the best diagnostic tests is vital. Pijuán’s doctor states that “there is something that has to do with the national level, can not be a patient, by being from a site or from another receiving a different diagnosis ”. An advertisement that has pathology services can “if we are well served, the patient will always have a better treatment”.
The search for these genetic alterations has significantly increased in recent years, thanks to the massive sequencing technique (next generation sequence of NGS), which allows us to study many genes in the tumor, and not only those that we know. If you are using new information, you will find new ones that you can study to see if the drug can work against you ”. In the laboratories of the Hospital del Mar, this technology allows pathologists work with panels of between 50 and 200 genes simultaneously.
In addition, technological advances in diagnostic tests and guided therapies have completely overtaken the type of more aggressive pulmonary cancer. Además, the results of the new treatments mejoran the obtenidos con conventional treatments such as chemotherapy and surgery, with the benefit for patients who “can have some punctual secondary effect, per not going to attack like a chemotherapy ”, apunta la pathóloga.
The three pillars that are currently in the cancer treatment series are the chemotherapy, direct therapies and immunotherapy. Treatments with immunotherapy are a reality in pulmonary cancer, obesity, rhinitis or melanoma, using the cane for surgery on other types of cancer, such as cysts. The immunotherapy function modifies and modulates the immune system for “What is the system of the individual the frame to detect the tumor cell and eliminate it”, developed by doctor García. The specialists hablan de una
“Authentic Therapeutic Revolution”, avalada por cada vez más investigaciones. As with immunotherapy, cancer agnostic abortion is needed more and more research to continue the advances.
The new therapies cambian the direction of the clinical trials
The agnostic approach to cancer has also changed the design of the clinical trials. Investigations that, traditionally, are centered on trying the efficiency of treatment before a cancer follows its location. Now, without embarrassment, with the identification of the molecular alterations and the development of the directed therapies, he began to develop another type of study, the ensayos basket o umbrella, in which the molecular alteration is prioritized.
Los ensayos sambreel son watellos que estudian different pharmacies in various variations which occurs in a determined location: for example, patients have pulmonary cancer before presenting distinct genetic alterations. The basketball teams, on the other hand, evaluate the efficiency of a pharmacy for a sole alteration, Independently of its location. That is, there are different tumors that share a biomarker.
The appearance of these new clinical trials has opened the door to more patients related to the opportunity to access agnostic therapies. In addition, it is especially important for the study of rare cancers or smallpox habitats. Organizations such as the FDA in the United States and the EMA in Europe consider the studies basket as acceptable methods for the authorization of these treatments and as such
follow up investigating the effectiveness of directive therapies.
If you do not have cancer or if the rest of your illness has been caused by the pandemic, you may have 20% less diagnostic this year, according to SEOM, regarding the availability of new treatments, “immunotherapy or precision medicine, we have helped a lot to adapt the treatment of our patients. To eliminate hospitalization, the oral therapists allowed us to send the medicine to the home and make checks using the telemedicine ”.