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Personalised medicine in cancer

In this step, we will hear how genomic technologies have impacted on the care of cancer patients
So my role is, initially, as a medical oncologist, and I’ve since diversified into genetics. So, primarily, I tend to see patients with ovarian cancer and sometimes breast cancer. And I do both the treatment of the patients– I also do the genetic testing. And later on– in my genetics role– I also tend to do the follow-up testing of their families. So I run the gauntlet from the cancer treatment right through to the family testing. So the biggest change that’s happened in cancer management in recent years has been the development of personalised medicine. And this is apparent in that, previously, we used to treat everybody with the same cancer with the same treatments.
And some people did very well and some people didn’t. Now, increasingly, we have realised that everybody’s cancer is a little bit different, and you can take into account changes that are present on the person’s tumour– which we call somatic changes– and also changes that are present in the person to offer them a more personalised form of treatment. So, firstly, if we look at the person’s tumour we can actually test the tumour to see whether or not they have certain receptors that are present on their tumour. And if those receptors are present, then we can offer patients drugs to target those receptors, allowing them to have a much more personalised and targeted treatment.
Now, the oldest example of this is actually in breast cancer, where we’ve tested people for receptors for oestrogen and progesterone on their tumour for many years. And if those receptors are present, then we’ve offered people hormone treatment to block those receptors. Now, over the last few years, we’ve found a number of additional receptors that are present in many different types of cancers which we can use targeted treatments to help improve the outcome of those cancers. We’re also interested in the susceptibility genes– or cancer susceptibility genes– that patients may have inherited through their family that may cause them to be at an increased risk of developing certain cancers.
And, again, the best known of these would be the BRCA1 and BRCA2 genes that became popular with Angelina Jolie a couple of years ago. Now, people who have cancer– usually ovarian or breast cancer– as a result of one of these genes also tend to respond in a certain way to certain types of chemotherapy and are also eligible for certain targeted treatments that target the deficiency in the cancer cells of people with these gene alterations. Again, allowing us to give people the best type of chemotherapy for them and for their particular cancer. Our patients have responded overwhelmingly positively to being offered more genetic testing. I think, historically– particularly with ovarian cancer– patients didn’t tend to be referred to genetics.
And so very few of them would have been offered genetic testing, even if they had a strong family history of breast or ovarian cancer. We’re now able to offer genetic testing to almost everybody with ovarian cancer that we see in the clinics, and it’s making a real difference– not only to the patient’s treatment, but also for the patients and allowing for us to determine the risk to the patient’s family of developing those same cancers in the future. I think, increasingly, genomic medicine is going to be the future of cancer treatments. I think the days are gone of us treating everybody with the same cancer in the same way.
And in order for us to give people the best possible treatment, that’s going to involve doing full profiling of every patient with their cancer and also their own personal risks when we meet them. I think that’s going to lead to much better outcomes for patients, and it’s also going to lead to patients being able to avoid side effects from treatments that wouldn’t otherwise be effective. So I say, increasingly, there is no way in which cancer treatment is not going to be able to incorporate genomic medicine.

The personalisation of medicine could bring huge benefits, especially for cancer patients.

It could allow earlier diagnosis of a disease or even identifying those at risk of disease, enabling more successful treatment or even prevention.

It could prevent money from being spent on unnecessary or futile therapies. It could reduce trial-and-error treatments and ensure that patients get optimum doses of optimum drugs.

Dr Angela George, Consultant in Oncogenetics, discusses how genomic technologies have impacted on the care of cancer patients.

Talking point

The funding of cancer treatments is always a difficult and contentious area, particularly for very expensive drugs used in terminally ill patients to prolong life.

Do you think the advent of personalised medicine will drive the costs of cancer treatments up or down?

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The Genomics Era: the Future of Genetics in Medicine

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