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Personalised medicine

Personalised medicine involves using information about a person’s cancer to help diagnose, treat and find out about how well treatment is working.

Generally, treatment for cancer depends on:

  • where in the body it starts
  • how big it is at the time of diagnosis
  • if it has spread (the stage)

So, everyone with the same type and stage of cancer would have the same treatment. But we know that this one size fits all approach works better for some people than others. 

Genes contain coded messages that tell cells how to behave. They control the growth and development of cells. Understanding more about the genetics of a cancer means that we know there are differences in the genes in cancer cells.

Researchers are developing treatments that target those differences. For example, trastuzumab (Herceptin) works on breast cancers that have a lot of a protein called HER2 but not for breast cancers that don’t have this protein. 

This is an area that researchers are still working on. Different cancers have different genetic changes and some have more than one change. So, we need a lot more research before everyone will be able to have treatment based on the genetic makeup of their individual cancer. 

Is personalised medicine available for me?

Scientists have been looking in detail at the biology of cancer cells. They've found that some cancer cells have particular proteins in the cell and others don’t. Sometimes, cancer cells have far more of a particular protein than healthy cells. 

Personalised medicine is at an early stage of development and we are learning more about it. Some people are already benefiting from this approach. Whether it is suitable for you depends on whether:

  • scientists have identified particular gene changes for your type of cancer
  • there is a test available for that gene change
  • there is a treatment that targets the particular gene change

How these new treatments work

Scientists are most interested in cell proteins that work as messengers within and between cancer cells. For example, a particular protein might tell cancer cells to divide so that the cancer grows.

Researchers are now developing drugs to target and block these messenger proteins. The idea is that blocking these proteins will stop cancers from growing and spreading. But the drugs are not suitable for everyone. They only work on cancers that have the protein they target.

Testing and treatments

Doctors need to do very specific tests on cancers to find out which changes there are inside cancer cells. This is a new and developing area. At the moment only a few of these tests are available for a small number of cell changes in certain types of cancer. 

Some drugs are already linked to available tests.

Chronic myeloid leukaemia

A gene change called Bcr/Abl is found in most chronic myeloid leukaemias. There is now a test for this. You are likely to respond to a drug called imatinib (Glivec), if your leukaemia cells test positive for Bcr/Abl

Lung cancer

A gene change in some lung cancers encourages the cancer cells to grow uncontrollably. This is called the epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation. Doctors can test for it. If your cancer cells test positive the cancer may respond to drugs called afatinib, erlotinib, and gefitinib. 

Some lung cancers have an overactive version of an enzyme called anaplastic lymphoma kinase (ALK). Doctors can test for this, and they call it ALK positive disease. Crizotinib and ceritinib are drugs that only work in cancer cells with have an overactive version of ALK.

Breast cancer

Hormones are made naturally in the body. They control the growth and activity of normal cells. These hormones stimulate the growth of some breast cancer cells. Around 7 out of 10 breast cancers (70%) have oestrogen receptors (ER positive). Your doctor checks your cancer cells for these receptors when you are diagnosed.

Oestrogen diagram

Tamoxifen works by blocking the oestrogen receptors, so stops oestrogen from telling the cancer cells to grow.

Bowel cancer

Some bowel cancers have an altered gene called K-RAS. Drugs called cetuximab (Erbitux) and panitumumab  (Vectibix) only work on cancers that have the normal version of this gene, which we can now test for.

Does personalised medicine always work?

Unfortunately, we can’t guarantee that any treatment will always be successful. Even when you've had the right tests and your cancer has a particular gene change, a targeted treatment doesn’t always work.

We think this is because there are many very complicated signalling pathways in cells. So, a treatment might not work because there are other changes in the cell we don’t know about, or don’t have a test for yet. Particular combinations of cell changes may interact. For example, we might block one signal that tells cancer cells to grow. But another signalling pathway might then be triggered, so the cells grow anyway.

Stratified Medicine

Stratified medicine means looking at large groups of cancer patients to find ways of predicting which treatments will work on which cancers. It’s one step towards personalised medicine.

In the first part of the programme (SMP1), researchers collected samples from around 9,000 people with different types of cancer. They looked at the different genetic changes (mutations) in the samples. This information will be used for future research.

This study has led to the next part of the programme, called SMP2. This is testing for genetic changes in non-small cell lung cancer. The people in the study have a small piece of their tumour and a blood sample sent for analysis.

The researchers will look for 28 different genetic mutations. Based on the mutation found, people might be able to take part in the National Lung Matrix trial. Researchers put the people taking part into treatment groups according to gene changes that have been found in their cancer cells. The drugs used are ones the researchers think will be the most successful based on the gene changes.

What next?

We will find out more about which treatments work with these and other cell changes as we continue with this area of research.

Cancer Research UK is working with the NHS and pharmaceutical and medical companies to develop more tests and make them available in the NHS.

Last reviewed: 
27 Sep 2017
  • Cancer Research UK Clinical Trials Database

    Accessed August 2017

  • All about KRAS for clinical oncology practice: gene profile, clinical implications and laboratory recommendations for somatic mutational testing in colorectal cancer

    H Linardou and others

    Cancer Treatment Reviews, 2011. Volume 37, Issue 3

  • Crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer

    National Institute for Health and Care Excellence, 2016

  • Improving outcomes through personalised medicine

    NHS England, 2016

  • Cancer Principles and Practice of Oncology

    VT DeVita, TS Lawrence and SA Rosenberg

    Lippincott Williams and Wilkins, 2011

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular test or treatment you are interested in

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