What is Medicine personalized?
personalized medicine can be defined as: “The right medicine for the right patient, at the right time”. In 2012, 2.6 million Europeans been diagnosed with cancer. Despite the big number of lives saved by early diagnosis and improved treatment, cancer remains the second leading cause of death, with 1.3 million deaths in Europe every year.
The aging of the population should increase the burden of cancer in Europe, which could affect 3.2 million new people and cause 1.7 million deaths in 2030. In 2008, 12.7 million new cases were diagnosed and the cancer caused 7.6 million deaths worldwide.
For the United States, those figures were 1.4 million new cases and 0.6 million dead. In recent years, we have witnessed many advances in the treatment of most tumors, which resulted in an increase in survival rate and improved quality of life.
We also have a lot made progress on lung cancer, breast cancer and colon cancer, which are the tumors with the highest incidence. And progress has also been performed for rarer tumours.
In particular, the last decade has seen the launch and promotion of a new concept of personalized therapy, where “personalized” ideally means “to administer the best treatment to each individual patient”.
It is generally accepted that personalized medicine is moving away from the process “one size fits all” to get closer to a “tailor-made” care concept, based on the biological characteristics of the person in his socio-cultural environment and specific environment.
The long-term promise of medicine personalized is not only to offer a more effective treatment to patients, but also to prevent the disease based on genetic prediction and on the physiological state of the patient throughout his life.
What is personalized medicine?
I will try to explain what we medical oncologists mean by personalized medicine. First, personalized medicine does not mean that we do what we want with a patient: the treatment is always determined by the medical protocol based on evidence that has made effective treatments a gold standard, or the ideal in the current state of knowledge.
Personalized medicine is the result of dedicated research efforts understand the complexity of cancer over the past 20 to 30 years 9 born. Whether between various types of tumors and organs or within any tumor, heterogeneity is the rule!
Therefore, while it is generally effective to administer the same type of treatment to patients whose tumor affects the same organ (breast, lung, prostate or other), this is unfortunately not the case for everyone.
For five to ten years, we have discovered that it was possible to stratify, for a type of tumor particular, different groups of patients and pathological characteristics for which certain molecular aspects, certain biomarkers or certain genetic alterations differed.
By For example, we have identified a subset of breast cancer patients who present amplification and overexpression of the HER2 gene; there are effective therapies for these patient. However, this is only the first milestone in our quest for personalized medicine.
Current research analyzes the mutation and expression of the gene and, thanks to available technologies, we can go even further and describe, for example, why 30 to 50% of women Unfortunately, HER2-positive breast cancers do not respond to anti-HER2 therapies, or why mechanisms of resistance to treatment develop.
Thus, the goal of personalization of medicine is to better understand the biology and patho- tumor logy of each patient.
The major idea is that going from a pathology of an organ (can- cer of the breast) to a stratified pathology (positive or negative HER2 tumour) then to a HER tumor positive in a patient with all of these gene activation features can help us to understand what is the most effective therapeutic strategy and to determine if we have appropriate medications to implement it
What is the purpose of personalized medicine?
The goal of personalized medicine is unquestionably to improve the effectiveness of treatment for patients. A very small step forward in this process consists of trying to identify the main molecular motor each patient’s tumor. We must take into account the differences between patients with the same type of cancer.
For example, each patient with breast or bowel cancer has a single tumour. This knowledge is completely new, and the medical community strives to identify the type of disease of each patient in order to administer the drug that will be most effective in his particular case.
We are progressing with a phenomenal amount of data and new knowledge on the genetic characteristics, and the changes resulting proteomic elements* in the tumor. The issue now is to succeed in exploiting this information in order to be able to propose a treatment targeted and improve overall patient care.
In my opinion, all sectors of oncology are affected by this development. We know that the development of cancer is a multi-phase process. Aus- if, by learning to understand serial changes at the cellular level, we can find ways to target these different phases in each tumor.
The two main questions currently being asked are political: 1. What should be the research priority, in terms of time and funding? 2. How can we ensure equitable accessibility to these new, expensive technologies strategies and therapies?
The answer to these questions will likely drive the priority of discoveries, but will not change. not the fact that personalized medicine will eventually concern each type of tumor
Personalization treatments oncology:
historical For years we have classified the tumors according to their site of origin, using a classification system called “TNM”. Researchers and clinicians thought that all cancers deriving from a same site were biologically similar and differed no doubt only in their histopathological grade.
This is a score which ranks tumors on a scale of 1 at 3, with 1 representing the least aggressive and 3, the most undifferentiated. Other clinical differences have been identified based on the presence of regional nodular metastases or metastases distant.
Most tumors were therefore classified according to the “TNM” or T system. represents the diameter of the main tumor, N the presence of regional nodules and M, distant metastases. For at least three decades, the personalization of oncology has been based exclusively on these three parameters and on the physical condition of the patient.
Again today, they are the basis of therapeutic decisions. There was a time when the chemotherapy, surgery and radiation therapy were the only treatment options for cancer.
These treatments are still relevant, but oncologists know that some patients respond better than others to certain medications and that the surgical approach is not always indicated. In recent years, researchers have studied several thousand samples of all types of tumours.
They discovered that tumors arising from the same site body could show significant differences. First in terms of histology*. The pathologist can distinguish different sub- types of cancer under the microscope. When a diagnosis of cancer is made, the patient undergoes a biopsy or an aspiration carried out by a fine needle.
With some tumours, the reduction or removal of the primary tumor also makes it possible to carry out a tissue sample for examination. Cells from the resected tumor are collected and analyzed.
This examination allows the pathologist to confirm the diagnosis of cancer but also, from specific stainings of the sample, to provide clinicians with a wealth of additional information such as the characterization histology of the tumour, its sensitivity to hormones or its grade of differentiation.
For example, in the treatment of lung cancer, histology provides tools very useful for selecting the most suitable drug for the treatment of the patient.
Of the clinical studies have shown that for a patient with pulmonary adenocarcinoma, chances of response may be higher by adding pemetrexed or bevacizumab to chemotherapy. For a patient with lung cancer squamous cell*, it would be more beneficial to add gemcitabine or vinorelbine.
