In a recent editorial published in the Expert Review of Gastroenterology & Hepatology, Lawrence Penn Chair of Bowel Cancer Research Professor Mark Molloy and Colorectal Surgeon Professor Alexander Engel highlighted the value of applying molecular technologies to discover what causes a bowel polyp to become cancerous and what drives the spread of disease.
Molecular technologies include genomics (the study of all the genes), proteomics (the study of all the proteins), and metabolomics (the study of all the metabolites).
To understand the biology underlying cancer, scientists have traditionally studied cancer genes – the genome.
That analysis has shown that bowel cancers are not uniform and can be subdivided into at least four types, based on molecular features they possess.
However, a blind spot in research has been the study of all the proteins – the proteome – which is the molecular machinery of the cell.
Cancer proteomics is an important new frontier in cancer research. It uses mass spectrometry, a powerful analytical technique for identifying proteins and measuring the quantity of each type of protein that is present.
"We need to look at the things that the genes are producing, and that's what proteomics is about," explained Professor Molloy.
"By studying how protein structure and function change when diseases such as cancer are present, we are hoping to identify which specific proteins play a role in bowel cancer," Professor Molloy added.
Knowing which proteins are present in bowel cancer is essential for developing new cancer treatments and for using existing treatments as efficiently as possible because most of the drugs used to treat diseases such as cancer interact with proteins.
Molecular analysis can improve the understanding of tumour biology and help clinicians make decisions about treatment.
It is an area of research that could have a profound impact on the care of bowel cancer patients.
“There is no doubt that technology is driving a big revolution in clinical care,” Professor Molloy said.
One example of this technological transformation is the use of mass spectrometers – sophisticated weighing devices that allow researchers to determine the molecular make-up of various substances.
With two new mass spectrometers installed at the Kolling Institute, Professor Molloy and his team analyse the molecular features of proteins and metabolites in individual tumours, to tailor treatment pathways according to the needs of each patient.
"When combined with genomic analysis, this gives us a more complete molecular picture of bowel cancer, which is essential to better understand prevention and treatment strategies," Professor Molloy said.
Mass spectrometers could also be used to monitor medication levels in a patient’s system, allowing clinicians to deliver a dose precisely calibrated to suit the individual.
“Currently those decisions are based on BMI [body mass index],” said Professor Molloy.
“But people metabolise these drugs differently based on genetics … By applying molecular analysis techniques to blood samples, the oncologist could potentially adjust the medication levels up or down in a more precise and personalised way.”
The goal is to find ways of integrating molecular analysis into everyday patient care.
Professor Molloy envisages that within the next five years clinical teams working with bowel cancer patients could include a molecular scientist.
“Today, these multidisciplinary teams discuss imaging, surgery, approaches to chemotherapy and so on,” he said.
“I’d like to see clinicians also asking how molecular analysis could help add to the fuller picture.”
Professor Molloy and Professor Engel imagine a future where precision medicine based on molecular analysis will improve current practice guidelines and be regularly used to inform treatment decisions in the diagnosis and prognosis of bowel tumours, in addition to guiding bowel cancer treatment.
Precision medicine allows oncologists to tailor treatment in a way that targets the specific weaknesses in each patient's cancer tumour.
By providing the right treatment at the right time, treatment can be delivered with greater accuracy and efficiency, while providing better quality care for bowel cancer patients.
The idea behind precision medicine is to test every patient's tumour to identify which mutations have become critical for it to survive and then choose a targeted medicine to counter-act the mutation - destroying or shrinking the tumour.
The concept of targeting specific cells isn't new; what is new is the depth of understanding that is now available due to a revolution in genetics which has made it possible for scientists to quickly and inexpensively probe a cancer’s damaged DNA.
Precision medicine allows oncologists to tailor treatment types to genomes in order to determine the best dose for the patient who has undergone screening for genetic diseases.
It also provides a basis for understanding why two patients with the same diagnosis, receiving the same treatment for the same disease, respond differently - because cancers are not all the same - even those in the same tissue - which is why a tailored approach is necessary.
Precision medicine helps guide oncologists when selecting treatment options, enabling them to find a solution which limits side effects associated with toxicity.
>> To find out more about precision medicine, download our free resource: precision medicine
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