What to do if your body is resisting cancer treatment? Advanced therapies, personalised medicine to address resistance

New hope for cancer patients: Know about the revolutionary therapies, personalised medicine and cancer treatments that are changing the game!

Cancer treatment effectiveness can be assessed clinically or by tests like radiology or tumour marker blood tests. According to experts, doctors use a combination of clinical symptoms, imaging and biomarkers to assess the effectiveness of cancer treatment.

Cancer treatments are failing but these new innovations could be the answer!(Image by Shutterstock)

How can doctors assess whether a treatment is ineffective?

In an interview with HT Lifestyle, Dr Anjali Kulkarni, Vice President - RWE Strategy and Analytics and Oncologist at 4baseCare, shared, “In case of visible tumours like in the oral cavity the size of lesion can be checked. Sometimes if the symptoms like difficulty in swallowing continue then the doctors can conclude that treatment is not helping to relieve the symptoms.”

She revealed, “Most definitive is the imaging tests like PETCT , CT or MRI can assess the original tumour size and current tumour size after treatment and if there is no change in size or increase then the clinician can conclude that the treatment is ineffective. Increases in tumour markers like CA 125 or PSA can be indicators of ineffective treatment.”

Published in the journal Nature, a study provides new insights into how cancers evolve to adapt to changing environments and suggests ways to reduce drug resistance by combining therapies.(Pixabay)

Bringing his expertise to the same, Dr Sandeep Nayak, Director - Department of Surgical Oncology at Fortis Hospital in Bengaluru's Bannerghatta Road, pointed out how doctors can assess whether a treatment is ineffective -

1. Symptom Improvement: If the patient had symptoms caused by the cancer (e.g., pain, fatigue, or organ dysfunction), improvement in these symptoms can indicate that the treatment is working.
2. Imaging Studies: Scans such as PET-CT, MRI, or CT are used to measure the size and activity of tumors. A reduction in tumour size or metabolic activity (as seen on PET scans) suggests a positive response.
3. Biomarkers: Blood tests can measure tumor markers (e.g., PSA for prostate cancer, CA-125 for ovarian cancer) to track the cancer's progression or response to treatment.
4. Response Criteria: Oncologists use standardised criteria, such as RECIST (Response Evaluation Criteria in Solid Tumors), to evaluate the extent of tumor shrinkage or progression.
5. Liquid Biopsies: Emerging technologies like liquid biopsies can detect circulating tumor DNA (ctDNA) in the blood, providing real-time insights into treatment effectiveness and resistance.

Are there any new advancements in overcoming cancer treatment resistance? How does it help?

Dr Anjali Kulkarni highlighted, “Genomic testing helps to understand the possible drug resistance in some cancers. It helps identify the certain mutations which are associated with higher response to certain categories of drugs. For example, patients with BRCA mutations are often highly responsive to PARP inhibitors, which target DNA repair mechanisms. Genomic testing repeated over a period of time helps to identify the changing mutation profile which will help to modify treatment protocols.”

She added, “Pharmacogenomics is a specialised branch which investigates how changes in genes affect response to medications. There are bio simulation models which run on the genomic file of the patient and suggest the potential drug combinations. Tests like liquid biopsy which are blood-based tests to assess the changing mutation profile over time and could potentially be of help in identifying biomarkers of resistance and suggest alternate protocols.”

Though about 300 billion dollars have been spent worldwide over the last 15 years on development of cancer drugs, the medicines have not increased the lifespans of cancer patients substantially.(Shutterstock)

Dr Sandeep Nayak asserted, “Yes, significant advancements are being made to address treatment resistance. However, many of these are in research phase.” He explained -

1. Targeted Therapies: Drugs designed to target specific genetic mutations or pathways in cancer cells are becoming more precise. For example, second- and third-generation EGFR inhibitors can overcome resistance caused by specific mutations.
2. Immunotherapy: Advances in immune checkpoint inhibitors (e.g., anti-PD-1/PD-L1 therapies) and CAR-T cell therapy are helping to overcome resistance by harnessing the immune system to attack cancer cells.
3. Combination Therapies: Combining different treatments, such as chemotherapy with immunotherapy or targeted therapy, can prevent cancer cells from developing resistance.
4. Molecular Profiling: Genetic and molecular profiling of tumors allows doctors to identify resistance mechanisms and tailor treatments accordingly.
5. Epigenetic Drugs (experimental): Drugs targeting epigenetic changes, such as histone deacetylase inhibitors, are being developed to reverse resistance.
6. Nanotechnology (experimental): Nanoparticle-based drug delivery systems are being explored to improve drug targeting and reduce resistance.

What role does personalised medicine play in addressing treatment resistance in cancer?

Dr Anjali Kulkarni answered, “Personalised approach using genomic testing, transcriptome and pathway studies will help understand the mutation profile in depth. This will help clinician to prescribe optimal combinations of drugs or to change the drugs quickly.”

Dr Sandeep Nayak elaborated, “Personalised medicine plays a crucial role in overcoming treatment resistance by tailoring therapies to the unique genetic and molecular profile of a patient's cancer.” According to him, this approach includes -

1. Genomic Sequencing: Identifying mutations or alterations in cancer-related genes (e.g., BRCA1/2, KRAS, or ALK) helps determine which treatments are most likely to be effective.
2. Biomarker Testing: Testing for biomarkers like HER2 in breast cancer or PD-L1 in lung cancer can guide the use of targeted therapies or immunotherapies.
3. Adaptive Treatment Strategies: Personalised medicine allows for real-time adjustments to treatment based on how the cancer evolves, reducing the likelihood of resistance.
4. Clinical Trials: Patients with treatment-resistant cancers may benefit from enrolling in clinical trials that test novel therapies designed for specific genetic or molecular profiles.

By focusing on the individual characteristics of the cancer, personalized medicine increases the chances of treatment success and minimizes unnecessary side effects.

Disclaimer: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.