For each patient, an individualized solution

Fighting cancer is one of the areas that has benefited most from Precision Medicine

The pillars of Precision Medicine are easily identifiable in Oncology and Hematology, and can significantly contribute to the success of the fight against cancer. "Through molecular diagnosis, we have the opportunity to individualize oncological and hematological treatments, providing better outcomes," says Fernando Moura, medical manager at the Einstein Multiomics Center.

Currently, there is a blood test available to evaluate genes related to cancer risk in healthy individuals. These genetic prediction tests can support clinicians in recommending procedures that minimize the risks of developing cancer.

For example: it is possible to identify mutations in genes related to breast cancer that guide recommendation for surgical interventions. One case that has become public knowledge is that of actress Angelina Jolie, who removed her breasts after performing tests like these.

Understanding this scenario, Einstein developed the Predicta genetic test, which maps genes linked to at least 15 types of cancer, and offers genetic counseling so that the patient understands the real implications of the results found.

Currently, there is recommendation for screening for only five types of cancer: breast, cervix, intestinal, lung (in smoking individuals), and prostate. For all others, there is no formal indication for screening.

Soon, we will have blood tests capable of detecting fragments of tumor DNA (which are distinct from normal cells). Thus, it will be possible to identify other types of cancer, still in early stages. This technique is known as liquid biopsy on screening.

This other pillar of Precision Medicine will soon transform cancer screening, and is already assessed in Einstein. Example: through the Office of Validation and Incorporation of Innovative Technologies, opportunities arose, such as with Acuamark Diagnostics. This is an American biotechnology startup that has developed a liquid biopsy test for screening different types of cancer that has the potential to be more affordable than others available on the market. Einstein has worked on validating this innovation specifically for the Brazilian population.

Understanding molecular diagnostics makes it possible to personalize the treatment of lung cancer patients, for example. In the past, when only chemotherapy was available, the median overall survival of a patient with metastatic lung cancer was only eight months. Currently, when a classic EGFR mutation is found, there is the opportunity to offer molecular target treatment, conferring about 38 months of median overall survival, according to Fernando Moura.

Today, there are many therapeutic options, from immunotherapy to theranostic treatments, through target therapies and Interventional Medicine, each more appropriate to the particularities of a patient. To make the best choice, therefore, hospitals at the frontier of knowledge create multidisciplinary groups, with highly qualified professionals, to discuss cases, especially the most complex ones. They are tumor boards, which exist in Einstein.

"It seems simple, but organizing this structure and these moments requires a preparation of the hospital as a whole," says Nam Jin Kim, Einstein's medical director of Oncology.

Personalization also makes care more cost-effective; treatments are aimed at those who will actually benefit from them, saving money and resources in cases where they would be ineffective. The intention is to reach more Brazilians with quality cancer treatment. Einstein, for example, serves many SUS cancer patients through the Doutor Gilson de Cássia Marques de Carvalho Municipal Hospital – Vila Santa Catarina, and other public units it manages.