Why do we use a ‘fingers crossed’ approach to treating advanced cancer?

I remember first hearing about genomics testing for cancer, about a year after my diagnosis of secondary breast cancer.  I had failed on every line of treatment I’d been given, was fast running out of options and looking for a lifeline.  

I asked my oncologist about it and was told not to bother wasting my money on a £3000 test – ‘there are very few matchable treatments for likely breast cancer genes’ he said.  And that was that.  In the end, I got the last slot on an early-stage clinical trial, and am still on it after 5 years.  But genomics had nothing to do with that – it was just down to luck and my oncologist’s hunch that this trial might work for me.

If I had paid for that genomics test all those years ago, it would probably have indicated that the drug would work for me.  So shouldn’t we take guesswork and luck out of the mix when prescribing treatment for patients with advanced cancer, and make genomic (also known as DNA or molecular) testing standard of care?

Genomics testing has come a long way in the last five years.  Medical advances mean that we now know what kinds of DNA (gene) alteration cause cancers to grow and we are rapidly developing ways to target treatments to those errors in DNA. In the UK, more than 164,000 people die of cancer every year because they have run out of treatment options, but genomics testing could help many of those patients find new treatment lines.

Globally large multinationals are now investing in comprehensive genomic cancer testing and ESMO recommends it for metastatic patients.  Glasgow University has also developed a very affordable genomics test for use within the NHS, but sadly there is little interest in it from the government. Covid has caused major problems for cancer patients- screening stopped, surgery delayed, trials paused.    Comprehensive DNA cancer testing could help cancer survival for patients who have been ignored during covid, by expanding the treatment and trial options available to them. Data from this testing could also increase the pace of research into new treatments.  

Many drug trials aren’t completed because they have failed to find enough patients. All this is very costly and these costs are passed on to the healthcare systems and the taxpayers. Trials for new cancer drugs can take nearly 10 years to complete and average development costs run into millions and billions, but only one in 30 such drugs is successful.  However, trials that use genomic testing in patient-selection have higher overall success probabilities than trials without these biomarkers. The more trials that can recruit patients quickly and be completed, the more new drugs will become available faster and at lower costs, and this can result in more treatment options for patients and cheaper medicines to the healthcare system.

The promise of precision medicine – getting the right medicine to the right patient at the right time – could become a reality and save many cancer lives.  But it depends on genomic testing becoming routine.  We need to test patients as soon as their cancer becomes metastatic, and every time it progresses to see how the cancer DNA has mutated and what their next best treatment option is.  This would deliver a sea change in survival.  

So let’s get rid of the fingers crossed, lucky 4 leaf clover approach to people’s lives and use science instead.

lesley stephens

By MetUpUK Member, Lesley Stephens