When we hear the term cancer survivor, we form an image of a person who bravely fought cancer and defeated it. We have that notion of the difficulties that he/she had to go through due to chemotherapy or surgical interventions. The fact that cancer can be challenged head-on by virtue of targeted treatment is slowly picking up in India. Genetic Testing for various cancer types is enabling targeted treatment or what we call in the present age ‘Personalized Medicine’.
The journey of cancer treatment has come a long way from trial and error treatment to targeted therapy. Though there is a long way ahead to cover, the application range of genetic testing is converting it into mainstream testing for cancer patients. This is in turn changing the definition of cancer management- from surviving to challenging.
NGS-based Genetic Testing heading the charge against Cancer
A few years ago, the cancer management approach was based on the patient’s symptomatic outcomes and basic diagnostic tests. Today, in some cases like non-small cell lung cancer, testing for a genetic mutation in Cancer Patients has become a first-line approach to decide the class and generation of drugs to be prescribed. Certain gene mutations change the normal mechanism in which body functions and hence cause cancer. If these gene mutations are identified a proper course of action can be decided that precisely attacks the root-cause itself. This helps save a lot of time on deciding the course of action and helps clinician take a more informed decision on cancer management.
The decreasing costs of these tests are also adding to the increased acceptance. The first human genome sequencing costs $1 Billion, whereas the same can be done in a few thousand dollars. The test cost for smaller panels with a limited number of genes is further lower making it more accessible to the patients. A single gene test for cancer today costs even less than $ 100.
There are multiple success stories we come across where the take home message has changed from basic survival to fighting the cancer head to head. Getting cancer is not in our control but giving it a tough fight is.
Clarity at different Stages
It is a well-known fact that genetic testing is a lens that helps the clinician look at the cancer more closely. It is the clarity that genetic testing provides that helps the patients in different ways, may it be hereditary risk prediction even before the cancer has hit an individual or in the differential diagnosis, prognosis and therapy selection at an early stage or therapy monitoring and disease surveillance for relapse post the initial therapeutic steps.
Because of the awareness about hereditary breast and ovarian cancers (HBOC) in India, the acceptance of BRCA1 and BRCA2 gene mutation testing has increased manifold in the last few years. Though it has a therapeutic application, one of the most known applications is to evaluate the genetic mutation status that helps one understand whether he/she is at a higher risk of developing cancer in the future. Though some look at this as an unrequired knowledge, others pull their socks up and start preventive measures right up-front and be on high surveillance. This is the stage we have an upper hand over cancer in this head-to-head fight.
When it comes to early-stage cancer, what genetic testing provides in terms of clarity is the differential diagnosis, prognosis (to understand whether the cancer will be aggressive or not), and therapy selection, all having an application on the cancer management steps a clinician would take. An accurate differential diagnosis helps select a proper course of action, an accurate prognosis prediction helps a clinician understand the extent of aggressiveness of the treatment, whereas some gene mutations are indicative of which exact therapy to choose to combat cancer.
Routinizing Genetic Tests
While clinicians have increasingly started amalgamating genetic tests in their practices, there is a major portion of patients who are not aware of the broad applications of genetic testing. Being aware, sure, will be a first step towards changing the term ‘survivor’ to ‘fighter’.