Title : Personalized and Precision Oncology (PPO) to be set up via precision oncology strategy for cancer care team: Developing targeted lung cancer therapy and advancing personalized cancer care
Abstract:
Lung cancer is one of the leading causes of cancer death among both men and women, making up almost 25% of all cancer deaths. Meanwhile, in the realm of respiratory illnesses, numerous patients with lung or pulmonary malignancies do not respond well to existing therapies. Delayed diagnoses and inadequate treatments contribute to these challenges, along with adverse reactions or treatment limitations due to side?effects. However, recent advancements in understanding lung cancer and pre-cancer conditions have paved the way for PPM-guided treatments, considering individual genetic, molecular and environmental factors. Precision medicine, which accommodates individual differences in cancer susceptibility and response to treatments, aims to improve patient care. Innovative technologies, such as genomic sequencing and biomarker identification contribute to this approach, allowing for customized treatments and the identification of effective therapies. Additionally, the application of PPM resources in lung cancer treatment exemplifies the forefront of individualized care within respiratory medicine. Integrative multi-OMICS approaches are redefining PPM-guided cancer-related pulmonology by combining genomics, transcriptomics, proteomics, metabolomics, and epigenomics to provide a multi-layered understanding of lung cancer globally. These strategies enable robust biomarker identification, precise patient stratification, and predictive insights into therapeutic responses, surpassing the limitations of IT supportive multi-OMICS analyses. A comprehensive molecular tumor analysis integrating a combination of NGS methods offers the best chance for personalizing cancer care, enlarging the scope of therapy choices and offering potential new options for challenging cases, for instance metastatic tumors, rare cancer types, and cancers of un-known primary. Cutting-edge bioinformatics pipelines integrate the multiple data levels to construct Big Data and Data Sets and to generate a personalized tumor report. One key asset of this solution is the use of whole transcriptome data as a booster enhancing the sensitivity and information content of the diagnostic, predictive and prognostic tests. Up to now PPM-guided lung oncology has been largely relying on identifying key mutations in the tumor DNA by means of panel sequencing, a method scanning only designated cancer gene targets. Though the panel approach helps to orientate therapy choices for particular cancer types, many “hard to treat” tumors remain in need of more effective diagnostic solutions. Successful clinical translation requires standardized data integration, advanced interpretative frameworks, ethical oversight, and scalable computational platforms, paving the way for PPM-guided lung cancer care, including canonical cancer patients and pre-cancer persons-at-risk. Currently, all patients with suspicious lung cancer and non-smokers with other histologies should be tested for EGFR mutations, ALK rearrangements and ROS1 fusion. For instance, when harbouring an EGFR sensitising mutation, ALK or ROS1 rearrangements or BRAF mutations, patients with advanced NSCLC will receive bioguided therapy as first-line treatment (i.e. gefinitib, erlotinib or afatinib) or ALK/ROS1 TKI (crizotinib) or BRAF inhibitors (dabrafenib and trametinib), respectively. In this context, along with the above-mentioned canonical targeted medicines, theranostics is an innovative concept of personalized therapy that focuses on both the accurate selection of lung cancer patients and providing them with targeted radioligand cancer therapy to improve their prognosis. The integrated value chain of PPM-related oncology tools equips theranostics programs with state-of-the-art solutions at every step of the theranostics care pathway. PPM-guided pulmonology and lung cancer branch are entering a new era marked by innovation and personalization. The integration of advanced technologies with patient-centric care is transforming the diagnosis, treatment, and monitoring of PPM-guided lung cancer cases, including canonical lung cancer patients and pre-cancer persons-at-risk. That approach provides comprehensive, whole?process, and personalized diagnosis and treatment services for patients with complex lung cancer or complex drug resistance progression; provides guidance for further adjustment of drug use; and establishes a multidisciplinary cooperative team, improves the quality of evidence-based clinical diagnosis and biomarker-guided personalized targeted treatment, and optimizes the process of medical services.
