Understanding personalized cancer care is a critical part of many people’s health-care journey as they work towards overcoming their illness.
Sunnybrook Health Sciences Centre is home to the Odette Cancer Centre, the second largest cancer centre in Canada. The centre is leading the way in innovative cancer care that is designed to meet the unique needs of individual patients living with cancer.
At the latest Sunnybrook Speaker Series, experts from the centre shared their insights about personalized cancer care and how it is evolving.
Dr. Calvin Law, chief of the centre, described the transformative future of personalized cancer care as the health-care system moves away from a “one-size-fits-all approach” and instead focuses on each individual’s experience and treatment needs in order to achieve the best possible outcomes.
“At the end of the day, it is the individual patient who we are serving,” said Dr. Law. “The personalized care we provide needs to get better every day.”
How do Genes Play a Role in Personalized Cancer Care?
Tracy Graham, genetic counsellor and manager with the Odette Cancer Centre Genetics Program, shared her insights on how a person’s genes can play a role in the personalized cancer care they receive – something many patients might not be aware of.
“All cancer is genetic because there has to be genetic mutations occurring within the cells of our body for cancer to occur,” explained Graham. “But only five to ten percent of cancer is hereditary.”
Genetic testing can be done for both hereditary cancers (germline mutations) and those which are acquired throughout a person’s lifetime (somatic mutations) to help determine the most effective treatment options.
Often conducted with a simple blood or saliva test, genetic testing can also provide patients with a sense of closure by answering the question, Why was I diagnosed with cancer?, said Graham.
“For example, for a patient who is diagnosed with colorectal cancer in their 20s – which is a young age – finding out there is a hereditary genetic reason behind it sometimes gives them that explanation they are looking for.”
Genetic testing and counselling can also help guide screening and early detection for other types of cancer a person could be at risk of developing, as well as for their family members.
The Future of Precision Oncology
Dr. Eileen Rakovitch, program research director with the Odette Cancer Centre, explained that experts are trying to better understand why standardized cancer treatments are more effective for some patients than others.
A key goal for the future of cancer care is to shift towards personalized treatment for each individual, as opposed to the same approach being used for all patients with the same type of cancer.
Thanks to breakthrough scientific technologies, cancer researchers can now pinpoint the molecular profile of cancers in order to recommend optimal personalized treatment plans.
“With molecular profiling, we now can see this individual with breast cancer, for example, has a different molecular profile than others,” explained Dr. Rakovitch. “Once you do that, you can match and individualize the best drug or radiation treatment for that specific individual.”
Added Dr. Rakovitch: “This is going to enable us to direct better and more effective treatments to patients and help them avoid side effects of treatments that are ultimately not going to be effective. This is the future of cancer treatment.”
Targeting Cancer with Personalized Radiotherapy
Dr. Deepak Dinakaran, a radiation oncologist with the Odette Cancer Centre and scientist with the Sunnybrook Research Institute, discussed how advances in radiation treatment are also contributing to personalized cancer care.
Radiation therapy, also called radiotherapy, uses high energy X-rays targeted at the cancer site to damage cancer cells in the hopes of stopping the future growth and spread of the disease.
“Thanks to technological advances over the past 10 to 20 years, radiation oncology has evolved to better target the site of cancer and significantly reduce how much radiation is going to the rest of the body,” said Dr. Dinakaran. “This precision radiotherapy has allowed us to evolve what we can do clinically to help patients.”
The next frontier of radiation treatment, he said, is adaptive radiotherapy. This aims to adjust a patient’s treatment plan on any given day based on sudden changes within the body. In simple terms: If the tumour or cancer site requiring treatment has suddenly moved, instead of directing radiation where it may no longer be needed, a more accurate site of the body can be focused on.
“Currently it is very hard to adapt to those kinds of internal shifts, but that is what adaptive radiotherapy aims to do by leveraging leading-edge equipment and artificial intelligence for image analysis,” explained Dr. Dinakaran.
“All of this happens within minutes while the patient is still on the bed. It is still new and evolving, but it will really open up new opportunities in how to use radiotherapy.”
