I have heard about stratified medicine, what is it?
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Stratified medicine means looking at large groups of cancer patients to try and find ways of predicting which treatments cancers are likely to respond to. It involves looking in detail at the cancer cells and their genetic make up. Researchers want to find out if some treatments are more likely to work in cancers that have particular changes to their genes.
This is one step towards something called personalised medicine. Personalised medicine uses genetic and other information to diagnose and treat disease. Once we have carried out research with large groups of cancer patients, we may be able to predict response to treatments. Then we hope we will be able to tailor cancer treatment very precisely to an individual person’s cancer.
The video below explains Cancer Research UK's Stratified Medicine Programme
View a transcript of the video explaining Cancer Research UK's Stratified Medicine Programme
The first phase of the programme includes studies in which researchers are collecting genetic information about different cancer types. The researchers will be looking at how to test the genes in cancer cells. Doctors will collect blood and tissue samples from patients. The genetic information is stored in cancer registries.
You can find details of these studies on our clinical trials database. They include a study looking at how to test the genes in cancer cells (SMP1) and a study looking at how to test the genes in lung cancer cells (SMP2).
Currently doctors decide on your treatment by looking at
- Your type of cancer
- Where it is in the body
- The size of the cancer
- What the cancer cells look like
We know that this works for many people but not for all. So 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. Or sometimes cancer cells have far more of a particular protein than healthy cells. These differences between cells are caused by changes in the cancer cells’ genes. So you may hear people talk about genetic testing in relation to stratified medicine or personalised medicine. This means testing the genes in your cancer cells, not your normal genetic make up.
Scientists are most interested in cell proteins that work as messengers within and between cancer cells. For example, a particular protein may tell cancer cells to divide, so that the cancer grows.
Researchers are now developing drugs to target and block these messenger proteins. The aim is that blocking these proteins will stop cancers from growing and spreading. But the targeted drugs are not suitable for everyone. They will only work on cancers that have the protein they target.
Many of the newest cancer drugs target proteins on or inside cancer cells. For example, if you have breast cancer, your doctor will have tested your cancer cells to see if they will respond to a drug called Herceptin (trastuzumab). Only breast cancers that test strongly positive for the HER2 protein are likely to respond well.
So, now we know that two people with the same type of cancer may have differences in their cancer cells. The differences mean that the cancers will respond to different types of treatment. If your cancer doesn’t have a particular cell change, the medicine that targets that change won’t work.
Being told you can’t have a particular treatment may not sound like a step forward if you have cancer. But there is no point giving people treatments that won’t work. It will just cause unnecessary side effects. And there may be another treatment that would work better for them.
On a national level, many of these new medicines are expensive. Giving them to people who are most likely to benefit makes them more cost effective. This makes them more likely to be approved by the National Institute for Health and Care Excellence (NICE) or the Scottish Medicines Consortium (SMC) in Scotland. Then these treatments can become available on the NHS.
Doctors will 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 there are only a few of these tests available for a small number of cell changes in certain types of cancer. The tests are so specialised that they are not yet available in many cancer centres.
Some drugs are already linked to available tests.
A gene change called bcr/abl is found in most chronic myeloid leukaemias. There is now a test for this and if your leukaemia cells test positive, you are likely to respond to a drug called imatinib (Glivec).
There is a gene change in some lung cancers that encourages the cancer cells to grow uncontrollably. This is called epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation. We can test for this and if your cancer cells test positive the cancer may respond to a drug called gefitinib (Iressa).
Stratified medicine is at an early stage of development and we are learning more about it every day. Some people are already benefiting from this work. Whether it is suitable for you depends on whether
- Scientists have identified 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
We have listed above some of the tests and treatments that are currently available. But this is likely to become a much longer list in the next few years.
You can find out about the research and tests available for your type of cancer in our cancer types section. If research is going on, it will be on the research page in the treatment section for your cancer type. The National Lung Matrix trial is looking at a number of new treatments for the main types of non small cell lung cancer (NSCLC). The treatment will depend on changes to genes in the cancer cells.
We also need to build a network of labs that can do the gene tests. Cancer Research UK is working with the NHS, pharmaceutical companies and companies developing these tests to
- Develop more new tests
- Make them available within the NHS
It takes time to develop new tests. We have to make sure that any new test is sensitive at picking up any changes, and is accurate and reliable. It will be some time before everyone with cancer will be able to have treatment based on the genetic make up of their cancer.
Unfortunately we can’t guarantee that any treatment will always be successful. Even when you have 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 may 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 may block one signal that tells cancer cells to grow. But another signalling pathway may then be triggered, so the cells grow anyway.
We will find out more as we continue with this area of research into how gene changes affect cancer cells. We will find out more about which treatments work with each of these cell changes. And most importantly people will get the treatment they need, because we will have a national system in place for carrying out the tests.
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