As Molecular Profiling Takes Center Stage, There Is Hope For Targeted Treatments For Cancer Patients

The healthcare landscape is rapidly evolving, driven by the confluence of factors ranging from crises such as the pandemic to technological breakthroughs. At the forefront of this transformation is molecular medicine, where genetic testing and molecular profiling play an increasingly pivotal role in guiding treatment decisions and maximizing effectiveness.

Molecular pathology, a cornerstone of molecular medicine, delves deep into the genetic mutations that cause disease. By scrutinizing genetic mutations, gene expression patterns, and protein alterations, molecular pathologists gain critical insights into disease mechanisms, paving the way for personalized and targeted therapies. This approach enhances diagnostic accuracy and facilitates the development of tailored treatment regimens, ultimately improving patient outcomes.

Amy Cripps, MD, a distinguished medical oncologist, stands as a testament to the transformative impact of molecular medicine in her practice. Dr. Cripps brings a wealth of expertise to her field with a robust educational background. She graduated with a Bachelor of Science in Biology from the University of Mary Hardin-Baylor. Her curiosity in understanding the dynamics of cancer made her further interested in taking on a Clinical Fellowship in Medical Oncology from the University of California, San Francisco, and an MD from the University of Texas in Houston.

This medical oncologist emphasizes the transformative impact of molecular medicine in her practice. She observes, "The shift towards personalized treatments outside clinical trials marks an exciting departure from conventional chemotherapy, offering patients hope." Indeed, the advent of targeted therapies, guided by molecular testing, heralds a new era in cancer care, where treatments are tailored to the molecular profile of individual tumors.

Dr. Cripps recalls that the drug Herceptin, had been a significant breakthrough in the quest to cure breast cancer way back in 1998. It benefited nearly three million people since its approval, however, it worked best for people whose tumors are spurred to grow by the HER2 signal, which is only about one-fifth of breast cancer patients and is also found in other types of tumors. For people without this protein marker, this drug offered no benefits.

In 2022, researchers developed Enhertu, a drug that extended the lives of people with HER2+ breast cancer by several months or longer with fewer severe side effects than standard chemotherapies. A COTA survey in December 2021 revealed that 83% of oncologists believe real-world data is quite important to accelerate the development of life-saving cancer drugs and treatments.

The advent of molecular medicine has led to the development of multigene assays, which are revolutionizing the management of diseases like cancer. These assays not only aid in prognosis prediction but also inform treatment decisions, sparing patients unnecessary chemotherapy while optimizing therapeutic outcomes. These therapies may allow patients to take pills at home and not spend the entire day in the infusion chair or hospitalized. This has improved the quality of life for patients significantly, giving them more time to spend with their family and friends.

Targeted treatments have also been developed for tumors expressing specific mutations, providing hope for specified drug development. These treatments can differ from chemotherapy in that they may not kill hair or blood cells, cause nausea or vomiting, and are less risky for infections or bleeding due to decreased blood counts. The supportive care in oncology has significantly improved, allowing for better treatment of nausea, vomiting, and other side effects.

Dr. Amy Cripps highlights rapid progress in drug development and the potential for expedited trials, which can allow drugs to be approved by the FDA after phase 2 studies based on safety and efficacy data, and with confirmatory data from the phase 3 trial, which compares a control group with a placebo.

Though there is progress in many aspects, Dr. Cripps emphasizes the need for improvement in molecular testing time, which currently can take up to 2 to 3 weeks, or longer. She believes that speeding up the process by setting up testing technology and expediting insurance approval can help patients receive optimal treatment faster, thereby reducing patient wait times for results. She also remarks, "We still have insurance authorizations as a hurdle. These drugs can be very expensive, and so we have patients who have large copays; and while there may be foundation money available, the Pharmaceutical company may provide, either some copay assistance or free drugs. We still have a long way to go when it comes to those kinds of things. In the next 5 to 10 years, we anticipate a paradigm shift towards expedited processes and lesser hurdles to jump through." As the field continues to evolve, Dr. Cripps envisions a future where genetic testing becomes reflexive for all tumor types, enabling early intervention and improving treatment efficacy.

Beyond molecular diagnostics, Dr. Cripps emphasizes the importance of holistic patient care, advocating for comprehensive support services and integration of alternative therapies. Programs are now being implemented to check in with patients monthly or even weekly, ensuring they receive all necessary medications and other services such as home health. She underscores the significance of addressing social determinants of health and prioritizing patients' psychosocial well-being alongside medical interventions, sharing "It is essential to treat not only the patient but also the whole family and support system, working together for the same goal." The growing role of genetic testing and molecular profiling in guiding treatment decisions truly signifies a paradigm shift in healthcare delivery.