PERSONALized Medicine
Medicine has always been personalized, it’s only now that we are started applying the concept to developing treatment.
October 17, 2013 - I have devoted my life to treating breast cancer. And while the diagnosis strikes everyone hard, it is especially wrenching for women, who are often the essential core of many families. So when it comes to breast cancer, we treat the entire family.
There are many reasons to be hopeful. Treatments for cancer are improving every year. Many of these improvements are the result of targeted medicines, which are treatments that target certain genetic abnormalities. Today, these targeted medicines are widely used for the treatment of breast, lung, skin and blood cancers – and the list continues to grow.
Guiding the patient to their personalized treatment
In all the excitement about new targeted medicines, it’s important to remember that medicine as a discipline has always been personalized. As doctors, our job is to listen to our patients and to apply our training, skill and experience to chart a course that is uniquely suited for them. This role includes taking large data sets or studies of hundreds of people facing cancer and then trying to figure out if the information is applicable to the patient sitting in front of us in clinic.
We always have and will be the stewards of targeting treatment. The science behind many of these medicines can be complicated and nuanced. It involves information gleaned from different diagnostic tests that need to be assessed within the overall context of the patient’s disease and situation. As patients have access to more information and scientists know more about each individual’s tumor, we will have to work together as a patient-physician team to make targeted treatment decisions.
Breast cancer is a good example of this. Today, there are more than 20 different medicines to treat breast cancer, from chemotherapies, to hormonal therapies, to targeted medicines and antibody drug conjugates. Here is the really good news: when I started my career, treatment options were limited to five approved medications, and we were using other medications that were not well studied. These approaches seem somewhat archaic now.
While patients may hear about the next best treatment in the news or on the internet, physicians need to provide the context for that information particular to an individual patient’s situation. We have to consider the implications of treatment to daily life and life expectancy. Each situation is different because each patient is unique.
We used to treat patients facing breast cancer with extremely high doses of chemotherapy in hopes that the chemotherapy would hurt the cancer cells more than the normal cells. The world of cancer care no longer has to hurt the patient as much as the cancer. This is now the world of personalized, or targeted, treatment.
For those patients with early stage breast cancer, some of the decisions, such as what type of surgery they should have, will affect a woman’s entire life. With the majority of women living longer and longer with breast cancer, potential side effects from treatments become an increasingly larger part of the discussion about treatment options. For women who face these difficult decisions, data driven new technologies can help them understand exactly what the risks of a therapy are and what the benefits can be. All-in-all, when it comes to treating cancer, the ultimate calculus is about maximizing the quality and quantity of life. Our job as doctors is to serve as the guide, counselor and implementer of how our patients want to approach their disease and their circumstance.
Looking to the future
I am excited about the future of breast cancer research, and hope within my lifetime we will have a cure. Until that time comes, I am determined to do all I can to improve the lives of breast cancer patients and their families.
The more options we have enhance my ability to approach patients’ treatment in the way they feel most comfortable. Personalizing treatment is about treating the whole patient. Today, because of new medicines, we are better at treating cancer than we were even 10 years ago, and the lives of those affected by breast cancer are clearly benefitting.
These discoveries are hopefully leading to a future where cancer is just a disease, not a death sentence, and a disease with treatments that offer hope, improved quality of life, and cures.