Onco savvy: tumor RNA analysis can help choose an effective drug
Russian doctors have developed a special algorithm that automatically analyzes the results of RNA sequencing of cancer cells and determines which drug is best suited for a particular patient. Today, only 15-20% of patients with malignant tumors receive personalized therapy. The new approach will make it possible to use targeted drugs for almost all patients. According to experts, a sufficient number of effective cancer drugs have already been created, and the choice of the most suitable ones becomes crucial for successful treatment.
Algorithm for prescribing targeted drugs
Specialists of the Institute of Personalized Oncology of Sechenov University have started to apply in practice a new algorithm that allows to prescribe the most suitable target drug to a patient based on the analysis of the results of RNA sequencing of cancer samples. The development was created with the participation of employees of MIPT and other Russian research organizations.
Until recently, drugs targeting individual targets were prescribed only to patients with diagnostic mutations in DNA. However, this is only 15-20% of patients with cancer, as in the rest these markers were simply not detected. The new approach will make targeted therapy available to virtually all cancer patients.
- Selecting therapies based on RNA profiles significantly increases the chance of finding a truly effective treatment for an individual patient. Routinely used today selection of treatment based on diagnostic DNA mutations is useful only for 15-20% of cancer patients, as in the rest such mutations are simply not found in the tumor. Determining treatment tactics based on RNA analysis will be useful for almost all patients. The introduction of this technology will help to increase the life expectancy of tens of thousands of patients with late-stage tumors," said Anton Buzdin, chief researcher at the Institute of Personalized Oncology of Sechenov University, professor of the Russian Academy of Sciences.
The study of tumor gene expression using RNA sequencing shows which molecular targets of which anticancer drugs will be active for a particular tumor, and which ones will be ineffective. The algorithm identifies the altered activity of target genes and molecular pathways and selects those that will be maximally effective for a particular patient from a variety of existing anti-tumor drugs. The result of the analysis is provided as a ranking of more than 170 drugs.
To evaluate the algorithm's capabilities, a clinical trial was conducted involving 239 adult patients with advanced malignant, predominantly metastatic tumors. 135 of these patients were receiving drug therapy, with the remainder receiving palliative treatment or radiation therapy. 59% of participants were prescribed treatment according to algorithm recommendations, while the remainder were treated according to standard protocols.
Those who were assigned treatment based on individualized ratings had higher disease severity on average. However, it was these patients who had longer progression-free survival (the time during which the disease does not progress).
Efficacy in the final stages of cancer
In general, the results of the clinical study confirmed that the selection of anti-cancer therapy based on the analysis of tumor RNA allows almost doubling the probability of response to therapy in advanced stages of cancer, as well as increasing the relapse-free period by an average of 10 months.
- It should be noted that we are talking here mainly about patients at the fourth stage of cancer with metastases. That is, this is the most severe group of patients. And even in this group algorithmically selected therapy has shown very high efficiency, - added Anton Buzdin.
Today, as a result of hard work of scientists, researchers, pharmacists, technologists and doctors, many anti-cancer drugs have already been created. If according to the results of research they are of proper quality and have shown their effectiveness, it means that the drug is really effective. But if it does not help the patient, most likely, the issue is not that the drug does not work, but that it is not the drug that should be used in this situation, said Stanislav Ottavnov, head of the laboratory for the analysis of health indicators of the population of MIPT.
- Today's treatment standards, unfortunately, do not yet fully take into account the possibilities of personalized therapy. And there is still a lot to be done to make it more actively used, but this is the only right way. In fact, there are no ineffective drugs, there are not fully justified prescriptions, and this is not even the mistake of an individual doctor, but the mistake of the whole system - only the wide introduction of personalized medicine will help us to solve the problem, - said Stanislav Ottavnov.
Technologies of full-genome sequencing have been used in the USA and Europe for a long time. The range of parameters that are taken into account in the analysis is constantly expanding, and now up to 600 parameters are tested. In Russia, many laboratories are trying to do something similar. Their success will depend on the list of genes analyzed. The emergence of a new algorithm can only be welcomed, the main thing is that the results of its use should be as reliable as abroad, said Andrei Pylev, chief oncologist at the European Clinic of Surgery and Oncology.
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