A pioneering approach to personalised cancer care where therapy is genetically tailored to individuals’ tumours is to be offered to NHS patients for the first time. Up to 6,000 cancer patients a year will have their tumours analysed for a wide range of genetic defects that can help doctors to choose the most effective therapy in an initiative that promises to transform the way the disease is treated, The Times has learnt.
The pilot scheme, to be launched in the autumn by Cancer Research UK, will examine how powerful genetic diagnostic techniques can best be rolled out across the NHS so that every cancer patient has the chance to benefit from the personalised treatment options they provide.
It will involve classifying individuals’ cancers according to the genetic mutations that drive them, rather than their position in the body. Smart drugs that target these mutations can be selected so that patients get the treatment that is most likely to work for them.
Scientists at the charity predict that this could become routine in as little as five years. As well as delivering better outcomes for patients, it should save the NHS money by reducing spending on expensive but ineffective therapies.
Harpal Kumar, chief executive of the charity, said: “We believe that cancer medicine has reached a point where increasingly the genetic characteristics of individuals’ tumours will and should dictate what treatments they receive. We now have enough genetic markers and drugs for this to make a real difference. It’s patently obvious that this is going to be the way of the future. In the long term, once the benefits are proven, the NHS should be doing this.”
In the past few years about two dozen targeted cancer drugs that attack specific genetic mutations have been developed, such as Herceptin for breast cancers with defective HER2 genes. They are effective, however, only when a certain mutation is present, so tumours must be tested first.
At present, NHS provision of these tests is patchy, and few patients are tested for more than one mutation. The Cancer Research UK scheme will change this by establishing some six centres that test tumours systematically for multiple mutations.
Patients whose cancers appear similar can then be divided into genetic subgroups with different treatment strategies. Lung cancers, for example, can be driven by different mutations, such as EGFR and BRAF. A patient with an EGFR defect could be prescribed erlotinib, an EGFR inhibitor, while one who tests positive for BRAF could join a trial of PLX4032, an experimental drug that targets this mutation.
Cancer Research UK has set up a scientific advisory panel to decide which types of cancer to include in the pilot and which mutations to test for. A team led by James Peach, the charity’s director of stratified medicine, is examining similar initiatives that are already running in the United States. At Massachusetts General Hospital in Boston, every patient admitted with late stage lung, breast, gastrointestinal, brain and melanoma skin cancer is now tested for mutations in 13 genes, to guide treatment decisions. Details of its programme are reported today in Eureka magazine in The Times.
Dr Kumar said that Britain could offer similar services on a more comprehensive basis. “If we get this right, there is no reason to believe that the UK can’t lead the world in this area,” he said. The scheme could also assist the drugs industry with the design of clinical trials of new targeted therapies. Professor Mike Richards, the NHS national clinical director for cancer, described it as a very exciting development: “There’s no doubt that this is the way forward for the future. The experience ... we get from these centres will tell us a lot about what genes we should be looking at.”
Professor Mike Stratton, director of the Cancer Genome Project at the Wellcome Trust Sanger Institute, said: “Discoveries of new cancer genes, of new drug targets and of new ways to predict whether patients will respond to particular therapies are accelerating, but a major challenge is how to obtain the benefits of these advances for patients in the NHS. This initiative will form the basis for doing just that.”
Saturday, June 05, 2010
Cancer patients to be offered personalised drug therapies - Times Online
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