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Precision oncology

Right treatment for the right patient at right time

Tasnim Ara | February 04, 2025 00:00:00


Cancer is a catastrophic medical challenge of this century, expected to impact millions more by 2040. According to GLOBOCAN 2022 by the International Agency for Research on Cancer (IARC), over 19.97 million new cases per year are expected to double globally by 2040. Seventy per cent of cancer patients are in low- and middle-income countries (LMIC), mainly in South Asia, including Bangladesh. Responsible for 9.7 million deaths in 2022, cancer suppresses the immune system and imposes a massive economic burden. The global cancer treatment cost is projected at $25.2 trillion (2020-2050). Alarmingly, only 30 per cent of low-income patients receive treatment compared to 90 per cent in high-income countries.

Cause of Cancer--DNA mutation and genetic instability: Environmental factors such as diet, pollution, radiation, and infections cause somatic mutations in DNA, responsible for 90 per cent of cancers. Inherited mutations in BRCA1/BRCA2 account for 5.0 per cent-10 per cent. Mutations in genes like PTEN lead to AKT pathway activation, while TP53 mutations disrupt tumor suppression, and RAS/RHO mutations activate ERK signaling, driving uncontrolled cell growth.

Understanding the disease at the molecular level is vital for effective treatment. Early detection is essential for combating cancer, involving:

• Confirming cancer subtype via immune histochemical staining (IMS). Detecting tumor burden through circulating tumor cells and biomarkers.

• Using molecular devices like PCR mutation analysis, genotyping, and next-generation sequencing.

These approaches lead to more precise and effective cancer treatments.

New era of cancer treatment--precision oncology: Now worldwide, in the era of Translational Medicine, with the discovery of the human genome, scientists have found genomic profiles and epigenetic phenomena causing cancer and different patterns of pathological conditions. Cancer is a complex disease due to multiple DNA mutations in genomic codes causing genetic instability that result in transformation of a normal cell into malignant cells. Changes in DNA sequences in a normal gene result in activation of Oncogene with alteration of balance between activation of Oncogenes with suppression or mutation in Tumor Suppressor Gene. Activation of Oncogenic transcription factors leads to upregulation of cellular signaling pathways with uncontrolled proliferation cells forming a "tumor or lump" within an organ or anywhere in the body, particularly Breast, Lung, Gastric, Colon, Prostate, Thyroid cancer including Leukemias and Lymphomas. Hyperactive dynamic malignant cells then invade the surrounding tissues as well as spread to distant areas of the body in the form of metastases resulting in organ failure and high mortality rate from cancer.

Precision Oncology, driven by personalised medicine, ensures the "Right treatment for the Right patient at the Right time." This advancement in medical science and biotechnology can revolutionise clinical practice. To offer the most effective treatment, understanding the genomic or molecular profiling of each cancer is crucial. In Bangladesh, we must assess the prevalence of genomic instability in cancer to tailor treatments and improve patient outcomes.

Recent advancements of Cancer Treatment

The field of cancer treatment has witnessed remarkable advancements in recent years, driven by breakthroughs in precision medicine, immunotherapy, and cutting-edge technologies. Here are some of the most notable advancements:

• Standard Therapy: Surgery, chemotherapy, and radiotherapy are conventional treatments. However, chemotherapy and radiotherapy can cause severe side effects and cancer recurrence due to chemo-radio resistance.

• Targeted Therapy: Newer treatments use drugs to target cancer cells specifically, identified through molecular diagnostics. These therapies have fewer side effects than traditional treatments.

• Immunotherapy & Immune-Based Cell Therapy: These therapies use modified immune cells (e.g., CAR-T cells) to target and destroy cancer cells. FDA-approved therapies have shown promise in curing hematological cancers, and research continues into gene therapy.

Cancer care in Bangladesh: With a population of 170 million, Bangladesh faces over 1.67 million cancer patients and 346,337 new cases annually. Though Bangladesh has made significant healthcare advancements in maternal and child health, cancer care needs improvement. Early detection and molecular diagnosis are crucial for better outcomes. Integrating advanced therapies like targeted therapies and immunotherapy could transform cancer treatment in Bangladesh, improving accessibility and effectiveness.

Role of SIFCIACT and BioMed: In 2020, SIFCIACT was set up to introduce Precision Oncology in Bangladesh in association with BioMed Diagnostics, a renowned general and molecular lab located in Sobhanbagh, Dhaka. Now Clinicians have the tools to personalize testing by application of biotechnologies and offer advanced modern treatment by confirming the correct molecular diagnosis of cancer among Bangladeshi cancer patients. Because of better diagnostic tests, patients are going to receive more effective treatment with the hope of completely controlling cancer and living longer with an improved quality of life. Based on proven experience in international institutions in USA, UK and Japan, SIFCIACT will like to introduce Targeted therapies, Immunotherapies, Immune based Cell therapy, CAR-T cells therapy or cellular products by using automated cell culture and expansion technologies to get the most effective outcome for cancer patients in Bangladesh. SIFCIACT will upgrade medical education particularly laying emphasis on highly specialized Bangladeshi doctors and skilled healthcare professionals who can take active participation to combat unmet medical challenges by adopting activities with the internationally renowned institutes to address the critical health concern facing the world today ranging from prevention, early diagnosis, improvement of standard of treatment.

The importance of detecting cancer early: The goal of screening exams is to find out cancer before they start to cause symptoms like a lump that can be felt but still confined to the organ of origin. Though the clinical outcome depends on receptor expression (phenotype) and mutations (genotype) patterns, prognosis still depends on the size and how far it has spread or metastasize in a patient with cancer.

Early detection tests save thousands of lives each year, and more lives could be saved, if even more people and their health care providers took advantage of these tests. Scientists may build a drug to hit one target, but a tumor employs many of yet-undiscovered genetic tricks to keep itself alive. Ongoing translational research and clinical application will help cure cancer completely in near future.

Prof Dr. Tasnim Ara, MBBS, MS, PhD, FACS is a Specialist in cancer-targeted therapy, surgical oncologist at Sinai Medical Center, Los Angeles CA, USA. She is also CEO, Salima Institute for Cancer Immunotherapy and Cell Therapy (SIFCIACT).

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