From a different test: how Russian scientists are changing breast cancer treatment
The first domestic test system for the selection of targeted therapy for breast cancer has been registered in Russia. With its help, oncologists and clinical laboratory specialists will identify mutations in genes that provoke the development of hereditary breast cancer. Izvestia found out details about how Russian scientists are changing breast cancer treatment in the country.
What is known about the new Russian test system?
The first domestic test system for the selection of targeted therapy for breast cancer (BC) has been registered in Russia. This was reported to Izvestia at Sechenov University. A genetic test created at the university for breast cancer patients has been named the Breast Cancer Target.
With its help, oncologists and clinical laboratory specialists will identify mutations in genes that provoke the development of hereditary breast cancer, and at the same time determine sensitivity to targeted drugs. As explained at the university, the new generation test combines the analysis of more than 20 genes.
It can detect hereditary and acquired mutations in a tumor sample, and then use it to select a treatment. So far, such testing has been used as a scientific technique at the Clinical Center for Health Sciences at Sechenov University, and now that the product has received a registration certificate from Roszdravnadzor, it will be able to be sent to other clinics.
"Obtaining a registration certificate will allow us to bring this high—tech scientific technique to a new practical level of application and in the future it will enable its introduction into the compulsory medical insurance system," said Marina Sekacheva, head of the Laboratory of Applied Genomic Technologies, Director of the Institute of Personalized Oncology at Sechenov University.
The test system was developed at the Industrial Laboratory of Applied Genomic Technologies of the First Moscow State Medical University in collaboration with the OncoAtlas Center for Molecular Oncology. Previously, it had successfully passed clinical trials at the P. A. Herzen Moscow Cancer Research Institute. The project was implemented within the framework of the "Priority 2030" program (national project "Youth and Children").
What is the unique development of Sechenov University?
As Marina Sekacheva explained to Izvestia, the uniqueness of the Russian test system is that it makes it possible to perform all the necessary studies at once to prescribe personalized therapy to patients with breast cancer.
With the help of a single test, the doctor gets all the answers to questions about further treatment tactics and can monitor the effectiveness of the therapy performed. The system uses a fundamentally new technique — sequencing of tumor material, which increases the accuracy and speed of treatment by 30%.
— A biopsy tissue from a tumor is used for the study, from which a tumor block is formed. Then, genetic material is isolated from this tissue, which is read in a sequencer. This is how we identify the genetic mutations for which effective targeted drugs exist. It takes about two weeks from the receipt of the material in the genetic laboratory to the receipt of the result — the selection of personalized treatment," said the director of the Institute of Personalized Oncology at Sechenov University.
For comparison, she explained, today every single mutation requires a study, which takes about 10 days on average. In the new test system, about 20 such changes are determined in two weeks. This means that the process of diagnosis and prescribing the most accurate, personalized therapy is significantly accelerated.
According to Sekacheva, similar systems exist in other countries, but they have not been created in Russia so far. In the future, scientists plan to develop genetic tests for the selection of targeted therapy for prostate cancer and lung cancer.
How will the new development change the treatment of Russian women?
The test systems are unique in that they allow for a personalized approach to the treatment of breast cancer patients, Pavel Koposov, Deputy Director of the Institute of Oncology and Chief Medical Oncologist at the European Medical Center (EMC), explains to Izvestia.
— Breast cancer is a polymorphic, that is, a heterogeneous disease with the appearance of cancer cells from the ducts or lobules of the breast. These neoplasms have a pronounced heterogeneity, and universal approaches, such as preoperative chemotherapy, may be excessive or even ineffective for patients. Modern test systems allow us to look into the tumor's oncogenome and determine its "molecular passport." We are looking for specific targets — these can be receptors on the surface of cancer cells or damage in their genome," says Koposov.
Thus, the new approach solves two key tasks. First of all, it allows you to determine whether a patient needs chemotherapy. If it is revealed that she has a tumor with a highly pronounced hormonal sensitivity and there are no mutations predicting the benefits of chemotherapy, it becomes clear that the patient needs hormone therapy.
— If the analysis reveals unfavorable molecular profiles associated with the high aggressiveness of the disease, with the risk of recurrence and the presence of genetic disorders sensitive to chemotherapy drugs, the appointment of chemotherapy is justified. Thus, the test determines the molecular profile of the tumor and allows you to choose the treatment individually, — says the interlocutor of Izvestia.
Secondly, he adds, test systems allow you to choose the right treatment for advanced stages. Here, again, genetic mutations or molecular disorders responsible for the development of the tumor are identified, and then drugs are prescribed that "target" vulnerable links.
"Thanks to this, the diagnosis, which until recently sounded like a death sentence, can become a chronic, controlled condition — the patient continues to live a high—quality life, receive the necessary treatment and return to normal life," concludes the professor.
What problems remain in the diagnosis and treatment of breast cancer?
According to WHO, breast cancer (BC) ranks first in the structure of oncological diseases in women. In 2022, 2.3 million new cases of breast cancer and 670,000 deaths were detected worldwide. According to experts, this number will only grow: by 2050 it will reach 3.2 million new diseases per year, and the number of deaths will reach 1.1 million. Overall, the incidence of breast cancer will increase by almost 40%.
However, Pavel Koposov notes, the essence of the problem is not only in numbers: in young women aged 25-35, cancer with a molecular profile is often detected already at late stages. In these cases, it is necessary to urgently address the issues of preserving reproductive function, since chemotherapy carries serious risks to reproductive health.
— There are also situations when cancer is detected during pregnancy, and already in the late stages. And if the symptoms are attributed to normal changes, the diagnosis is made too late — when there are already metastases. And then a difficult dilemma arises: is it possible to carry out chemotherapy during pregnancy? It is necessary to select medications that do not harm the development of the fetus, to carry out early delivery. All this is a life—threatening situation for both the mother and the child, - says the interlocutor of Izvestia.
Most often, this result is caused by the inefficiency of standard screening. Mammography is recommended from the age of 40, but the disease can also develop in young patients. In addition, about 15% of breast cancer cases are hereditary: women with such mutations should be examined at the age of 20-25, using more sensitive methods such as contrast-enhanced MRI. Therefore, it makes sense to undergo genetic testing.
According to the doctor, in general, the development of technologies, including the introduction of new test systems, can be called an important step towards the development of molecular oncology. This area opens up fundamentally new possibilities for diagnosis and treatment, requires constant professional growth from doctors, and gives a chance for effective treatment to a wide variety of patients.
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