Precision medicine cancer treatment. Recurrent thyroid cancer. Clinical case. 6

“Cancer is not a fixed disease. Cancer adapts and evolves. That’s the challenge in treating cancer. But you can do it now with precision medicine”. Leading precision medicine expert and oncologist discusses patient’s story. Treatment of metastatic thyroid cancer. Finding of specific new mutations by genomic tumor sequencing. Successful use of different targeted cancer therapies.

We talked a lot about new methods of cancer treatment. Is there a clinical case that you could think about. A particular patient perhaps? Dr. Anton Titov, MD. A case that illustrates how the new precision medicine and advances in oncology are helping real people in the world today. Sure! We try look not just at the simple pathology. Especially for patients with metastatic disease, we try to take a thorough molecular profiling of the tumor. In some cases we see molecular targets that we couldn’t predict before doing this specific genetic test. We can try new cancer medications. Sometimes we see wonderful results, wonderful successes. For example, we had a patient with metastatic thyroid cancer. We found the specific mutation, so we put her on a clinical trial with cancer therapies against that specific mutation. Dr. Ido Wolf, MD. That cancer therapy worked for about three years. That was  amazing and she had wonderful quality of life at that time. But then she progressed with her thyroid cancer. We took another biopsy and we found a new mutation. We gave the patient another medication, and she lived again for another period. Dr. Ido Wolf, MD. This is what we try to do now. We try to take the lab, “the bench to the bedside” approach. Dr. Ido Wolf, MD. That means trying to look at tumors not just in the beginning, at the time of cancer diagnosis. But we also take biopsies throughout the cancer course. We want to see what happens to the tumor. we want to see if tumors change. We want to look at the biological and mutational landscape of cancer tumor. We want to see how that can help us to guide cancer treatments of the patients. In other words, in that particular patient with thyroid cancer you addressed the molecular escape of the tumor at least twice. Because the cancerous mutations evolved. Because of cancer treatment and tumor evolution in metastatic disease, mutations at cancer recurrence were different. Dr. Ido Wolf, MD. Dr. Anton Titov, MD. You were able to use different medications targeting those cancer mutations sequentially. Exactly, because the tumor evolves. We cannot make decisions about tumors just according to the first tumor analysis that we saw first when a patient came to us. The tumor evolves and we must learn and study this evolution. We must try to target the tumor on its way, as it evolves. Cancer is not a fixed disease. Cancer is clearly the sort of the disease that adapts and evolves. Dr. Ido Wolf, MD. That is the challenge in treating cancer. This is something that you can do now with precision medicine. Exactly! The cancer evolves, tumor changes with time. The tumor that the patient got today is different from the tumor that he will have a year from now. Cancer changes with location, just as we discussed with the metastases. We know that the tumor in the metastases in the liver or the brain is different from the primary tumor. Cancer changes with treatment. For example, mutations in the estrogen receptor appear following breast cancer treatment. Dr. Ido Wolf, MD. We have multiple factors that drive the evolution of the tumor.