A recent article in Med City News outlines the difficult choices patients must make regarding immune compromising but life-saving therapy during the 2020 pandemic.
Do they postpone their treatment or do they venture out to hospitals and treatment centers risking exposure?
The pandemic has also reduced treatment options such as the availability of clinical trials that are often the only hope for advanced cancer patients.
Clinical trials are usually conducted at major academic institutions creating difficulty for many patients who are unable to travel.
Dan Rhodes, CEO of Strata Oncology, added that the promise of Precision Medicine to get the right drug to the right person should include “to the right place”. Making them available locally.
Advances in Precision Medicine
Although cancer patients generally have the same “type” of cancer, variations (subtypes) can forecast the patient’s response to different treatments. In precision medicine, the patient’s oncologist relies on the patient’s molecular information (molecular profile) in order to select the most effective treatment.
Many cancer treatments are now dependent upon molecular changes instead of the location of the tumor.
Thanks to advances in precision medicine, biomarkers are used as indicators to identify a “defined characteristic” that points to a specific therapy for a specific patient.
FDA Approval of Keytruda
The FDA gave its approval to pembroluzumab (Keytruda) earlier this year to treat any solid tumor that is TMB (tumor mutational burden).
TMB is a measurement of the number of gene mutations (changes) in a tumor that can be determined by a lab test. Cells with a high TMB are identified as being abnormal and would be attacked by the immune system.
TMB is a biomarker that is being studied to determine if it can predict whether a cancer patient will benefit from immune-oncology therapies.
Telehealth Protecting Hospital Staff
A hospital in Rochester, New York responded to being overwhelmed by COVID-19 patients by contacting Israel’s Datos Health regarding its telehealth program.
Within forty-eight hours, Datos delivered its automated remote-care program to Rochester. The program will protect its hospital staff and provide accurate remote managed care for patients in their homes.
The Datos program is designed to reduce the influx of visitors to emergency rooms and clinics thus easing the burden of an already overwhelmed medical staff.
Unfortunately, only fifteen percent of advance-stage cancer patients receive tumor profiling due to several obstacles.
- Tumor tissues. For example, out of approximately twenty thousand tumor tissues collected in an observational trial, less than half had a surface area that met minimum requirements.
- COVID-19 testing. Health systems are having difficulty arranging widespread testing or even transferring the test results into decision-making.
- Clinical trials. The COVID-19 pandemic is responsible for a decrease in clinical trial enrollment according to JAMA Network. This trend is expected to continue until the virus has stabilized.
The Road Forward
Several companies are in the process of developing liquid biopsies (blood tests). These tests identify circulating tumor cells in the blood. When perfected, the tests may eliminate painful tumor tissue and bone marrow biopsies.
Others are providing educational programs geared to genomic testing.
Companies are delivering programs in precision oncology for health systems. These programs provide access to tumor molecular profiling and biomarker-guided clinical trials.
An Anecdote From Kaiser Permanente
A spokesperson for Kaiser Permanente presented an anecdote at the ASCO 2020 meeting involving a seventy-year-old man with advanced lung cancer.
The patient’s tumor was tested using next-generation sequencing which is at the forefront of precision medicine.
Doctors found that he had a rare gene fusion that would respond to oral targeted treatment. The man has since been treated as an out-patient, avoiding exposure to COVID-19.
Health systems, providers, and pharmaceutical companies are working for a future that provides broad-scale genomic testing and improved access to clinical trials.