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Precision medicine is an approach to patient care that allows doctors to select treatments based on an individual’s genes, proteins, environment, and lifestyle. In cancer, precision medicine uses specific information about a person’s tumor to help diagnose, plan and monitor treatment, or make a prognosis.

The idea of precision medicine is not new, but this area of research has garnered more attention due to recent advances in science and technology.  Precision medicine shows much promise in the field of cancer therapy because it is an efficient and targeted approach to patient care that yields better outcomes and spares the patient from receiving treatments that do not work.

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The precision medicine approach to cancer treatment is not yet the standard of care for most patients. Many new treatments designed to target the specific genomic alterations that are driving the cancer growth are being tested now in clinical trials like NCI-MATCH (Molecular Analysis for Therapy Choice) and the American Society of Clinical Oncology’s TAPUR (Targeted Agent and Profiling Utilization Registry).

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Targeted therapies are the cornerstone of precision medicine with the ultimate goal of ridding the body of cancerous cells while leaving normal cells unharmed. Targeted therapies block the growth and spread of cancer by interfering with the molecules that are specifically involved in cancer cell growth and progression.

There are four major types of targeted therapies in breast cancer treatment: 1) Monoclonal Antibodies, 2) Small Molecule Inhibitors, 3) Immunotherapies, and 4) Hormonal Therapies

Monoclonal Antibodies

Antibodies target and bind to specific antigens (e.g. viruses, toxins) found on the outside or surface of the cell. Monoclonal antibodies are expensive and technically difficult to produce via bioengineering techniques. They are usually administered intravenously and can last in the body for days to weeks.  They have the ability to make cancers cells more obvious to the body’s immune system, block signals that trigger tumor cells to grow, and stop the formation of new blood vessels (angiogenesis), which is necessary for the growth of cancerous tumors.

Any generic drug names that end with the stem “-MAB” are Monoclonal AntiBodies. Monoclonal antibodies contain an additional stem in the middle of the name describing the molecule’s target.

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MONOCLONAL
ANTIBODY TARGET
STEM IN
MIDDLE
DRUG EXAMPLES
Tumor-T(U)Trastuzumab (Herceptin), Pertuzumab (Perjeta)
Immune system-LI(M)Pembrolizumab (Keytruda), Avelumab (Bavencio)
Circulatory system
(blood vessels)
-CI(R)Bevacizumab (Avastin)
Skeletal system (bone)-O(S)Denosumab (Xgeva)

Learn how the monoclonal antibodies, pertuzumab and trastuzumab, deliver a 1-2 punch to HER2+ breast cancer:

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Small Molecule Inhibitors

Like monoclonal antibodies, small molecules are drugs that interfere with essential processes in cancer cells. Whereas monoclonal antibodies attach to the outside of cancer cells, small molecules are much tinier than monoclonal antibodies and can penetrate inside cells to perform their work. They are less expensive than monoclonal antibodies and are manufactured by combining chemicals in a lab.  Small molecule inhibitors are usually taken orally and only last hours in the body. Any generic drug names that end with the stem “-IB” are small molecule inhIBitors.

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TYPES OF SMALL MOLECULE INHIBITORS DRUG NAME ENDINGSDRUG EXAMPLES
Tyrosine kinase inhibitors-TINIBLapatinib, Neratinib
Serine/threonine kinase inhibitors -SERTIBAlisertib, Vistusertib
CDK (cyclin-dependent kinase) inhibitors -CICLIBPalbociclib, Ribociclib
PI3K (phosphoinositide-3 kinase) inhibitors-LISIBAlpelisib,
Taselisib
PARP (poly ADP-ribose polymerase) inhibitors-PARIBNiraparib, Olaparib
Angiogenesis inhibitors-ANIBCediranib, Nintedanib
Rapidly accelerated fibrosarcoma (RAF) kinase Inhibitors -RAFENIBSorafenib

Learn how the small molecule PARP inhibitor, Olaparib (Lynparza), exploits a weakness in cancer cells:

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Immunotherapies

Immunotherapy cancer treatment is designed to harness the body’s own immune system to trigger a response that will destroy or enhance its resistance to cancer cells. Examples of immunotherapies either approved or being tested in clinical trials include:

  • Monoclonal antibodies that target specific features of cancer cells
  • Checkpoint inhibitors/immune modulators that stop cancer cells from turning off the immune system
  • Adoptive T-cell therapy/transfer that uses re-engineered immune cells to help the immune system work better
  • Therapeutic vaccines that help the body’s defenders recognize and destroy cancer cells
  • Oncolytic virus therapies that use modified viruses to kill cancer cells

Learn the mechanism of action of PD-L1 checkpoint inhibitors:

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Hormonal Therapies

Another form of targeted therapy is hormone therapy which slows or stops the growth of hormone-sensitive tumors, which require certain hormones to grow (e.g. estrogen or progesterone). Hormone therapies act by preventing the body from producing the hormones or by interfering with the action of the hormones to prevent cancer cell growth. There are three different types of hormone therapy each with a different mechanism of action:

1) Treatments that block the estrogen receptors on the surface of breast cancer cells or SERMs (Selective Estrogen Receptor Modulators). Examples include Tamoxifen and Toremifene (Fareston).

2) Treatments that block and damage estrogen receptors or SERDs (Selective Estrogen Receptor Degraders). Examples include Fulvestrant (Faslodex), Goserelin (Zoladex), and Leuprolide (Lupron).

3) Aromatase Inhibitors (AIs) that block the enzyme aromatase (which makes estrogen) and completely stop estrogen production. Examples include Letrozole (Femara), Anastrozole (Arimidex), Exemestane (Aromasin)

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SOURCES INCLUDE:
Cancer Support Community. CAR T-Cell Immunotherapy: A "Living Drug" to Fight Cancer. www.CancerSupportCommunity.org/CART. Accessed Nov 2017.

National Cancer Institute. Targeted therapy for cancer treatment. www.cancer.gov/about-cancer/treatment/types/targeted-therapies. Accessed Oct 2017.

Research Advocacy Network. Precision Medicine in Oncology. http://www.researchadvocacy.org/advocate-institute/precision-medicine-oncology-educational-resources. Accessed Nov 2017.


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