'New era' of personalised cancer drugs, say doctors

Cancer is entering a "new era" of personalised medicine with drugs targeted to the specific weaknesses
in each patient's tumour, say doctors. Precision medicine is one of the big themes at the annual meeting
of the American Society of Clinical Oncology.

Doctors say "breath-taking" advances in the understanding of tumours are being used to unlock new
treatments. But there are also concerns that patients are not getting access to the precision medicines
we already have. The premise of precision medicine is that cancers are not all the same - even those in
the same tissue - so a tailored approach is needed. It is the same approach as in football - you modify
your tactics to face Barcelona, Newcastle United or Skegness Town.

DNA clues

Cancers are normal cells that have become corrupted by mutations in their DNA that leads to
uncontrolled growth. Chemotherapy and radiotherapy kill everything, including healthy tissue.

The idea of precision medicine is to test every patient's tumour, find the mutations that have become
essential for it to survive and then select a targeted drug to counter-act the mutation - killing the
tumour. This concept is not new. Women with breast cancer already have their tumours analysed to
decide on treatment. Tumours whose growth is fuelled by oestrogen have drugs to block the female sex
hormone, while the drug Herceptin works in only the 20% of tumours that have specific mutations. But a
revolution in genetics - allowing scientists to rapidly and cheaply interrogate a cancer's corrupted DNA -
is leading to huge excitement about a new generation of precision drugs.

Prof Peter Johnson, the chief clinician at the charity Cancer Research UK, argues: "The idea of taking
something which is particular to cancer cells and targeting them isn't hugely new, what is new is our
depth of understanding. "I think it is a new era of understanding and it's driven by the technology
changes which have allowed us to decipher the cancer cells genetic codes at a level of detail that was
unimaginable 15 or 20 years ago. "So in that sense we have a fantastic range of new opportunities for
treating cancers."

Major advances

The world's largest cancer conference - a meeting of 30,000 doctors and scientists - has already heard
how a precision approach is helping to beat cancer. Dr Maria Schwaederle, from the centre for
personalised cancer therapy at the University of California, San Diego, has presented data on 346 highly
experimental clinical trials involving 13,203 patients.

Of the studies, 58 used a precision approach. Even though the trials were designed to test only for
toxicity, they also uncovered huge benefits for patients. Cancers shrank in 31% of cases when a drug was
matched to the tumour's weaknesses compared with just 5% of the time without. And the time before
the disease worsened increased from three months to nearly six months with precision medicine.
Dr Schwaederle said the findings were "striking" and praised the "breath-taking advances in our ability
to perform genomics" that was revealing the inner workings of tumours.

The UK's National Lung Matrix is already trying to match a new generation of targeted lung cancer drugs
to the unique flaws in patient's tumours. Meanwhile, another trial has been announced with the aim of
testing 4,500 women's breast cancers to see which patients need chemotherapy.

Dr Robert Stein, a consultant from University College London, said: "We would expect to reduce
chemotherapy within the trial population by about two thirds." Further data on treating patients with
precision medicine is due to be presented later.

Dr Daniel Hayes, who will take over as president of the American Society of Clinical Oncology, told the
BBC News website: "There's a lot going on, we're still in our infancy, but this is really starting to hit the
fan. "And frankly we're starting to become more precise in our precision medicine."

Missing out

Precision medicine should be hugely beneficial for patients as it also has far fewer side effects than
either chemotherapy or radiotherapy which kill healthy tissue as well as the tumour. However, there are
concerns that patients are already missing out on established drugs like crizotinib in lung cancer, or
dabrafenib in melanoma, that work effectively in a subset of patients.

An analysis by the charity Cancer Research UK found patients were not getting tested in order to get a
precision treatment. It said that in England alone there were 10,900 cases of bowel cancer each year,
but 4,900 were not offered a test to see if a precision drug would help. It estimates that at least 2,100
patients would have been suitable for a precision medicine that had already been developed. And in
lung cancer 1,400 missed out on drugs. But Prof Johnson concluded: "I think we're just in the foothills of
precision medicine at the moment, but we're really starting to get a grip on how treatments will work in
the future."