Why genetics of patient is equally important to genetics of tumor for colorectal cancer treatment? Why we should identify key gene mutations in patient for correct treatment? How to personalize colorectal cancer treatment according to patient’s genetics? Leading colorectal cancer oncologist and research expert discusses colon cancer diagnosis and treatment options.
There will be more than three stages of colorectal cancer classification when more research is done. Treatment of the patient will be personalized based on expected course of disease in a given patient. Dr. Anton Titov, MD. The question is then how to achieve personalization of colon cancer treatment. Currently most advanced methods are research-grade. They are not in routine clinical practice. Prof. Dr. Hans-Joachim Schmoll, MD. Many features of the colon cancer tumor and also of the patient will be analyzed to personalized therapy. There was a European cancer conference and the conference in the United States A few weeks ago. Different clinical trials of stage 4 colon cancer treatment were analyzed. The results of stage 4 colon cancer treatment trials are now known. They looked into the germline mutations in the patient's DNA. Not only tumor tiddue was analyzed. The normal DNA of the body has a lot of mutations and genetic variations. These genetic variation in patient's body do not create an illness. Prof. Dr. Hans-Joachim Schmoll, MD. But they influence the metabolism of chemotherapy medications. Normal human DNA polymorphisms influence how much toxicity patient has during chemotherapy. Dr. Anton Titov, MD. There are many possibilities for the germline mutations to influence colon cancer course. personalized medicine method not only predicts the genetic mutations in the tumor. Precision medicine looks at the genetic makeup of the patient. This helps to predict the response to therapy and potential toxicity. Prof. Dr. Hans-Joachim Schmoll, MD. Well said, correct. clinical trials analyzed different chemotherapy in stage 4 colorectal cancer patient genetic differences between patients had a huge influence on chemotherapy response from the tumor. The difference had a "p-value" of 0.001, highly significant. Dr. Anton Titov, MD. This different in how patients responded to treatment based on germ-line mutations was very significant. It was more significant than any change in treatment or any difference from one type of treatment to the other. genetic makeup of the patient is highly relevant for treatment. It was not known until now that this germ-line mutation influences the outcome of treatment so much. genetic makeup of the patient is another component this must go into colon cancer classification. To select personalized therapy for colon cancer patient, we must not only analyze the tumor mutations. Prof. Dr. Hans-Joachim Schmoll, MD. We must also analyze the makeup of normal body cells. This DNA is inherited but not changed by a mutation. Precision medicine is more and more complex. It requires big clinical trials with many many patients. Someday we will finish research. We will have a truly personalized medicine. It is probably not the case now. Personalized medicine means complete analysis of the tumor mutations and patient's genetic makeup. Then we can use patient's characteristics to adapt the treatment methods. Dr. Anton Titov, MD. We will base therapy on colon cancer prognosis coming from analysis of the tumor and the patient.