In recent years, individual cancer treatments have been one of the most popular topics. Many hospitals have set up an individualized treatment centre. The former president of the Anderson Cancer Hospital in United States retired and then established a large Individualized Cancer Institute.
Broadly speaking, individualized treatments include the individualized treatment on the overall level and the molecular level. Although there are different people with the same disease due to distinct genetic characteristics and expression, body condition and surroundings, the treatments should be not the same as each other. Even the medical treatment of the same patient at different stages during illness, should be different. Treatments vary with each individual and time, which is called individualized treatment.
Generally speaking, individualized treatments can be divided into the overall level and the molecular level. Traditional Chinese medicine has always stressed the concept of “the overall individualized treatment,” its essence lies in the diagnosis and treatment based on an overall analysis of the illness and patient’s condition, also treating the same disease with different methods and different diseases with the same method. Prescriptions by different traditional Chinese physicians are inconsistent and the effects are also different, which is because they have different considerations on the individual. Chinese medicine can be offered as a reference for cancer treatment. However, traditional Chinese medicine is to distinguish cold and heat, weak and strong, while the modern medical viewpoint on cancer treatment is to distinguish the stage of disease that includes genetic mutation, receptors and key enzymes.
When dealing with a patient’s tumor clinically, the questions are do we treat the patient with surgery or minimally invasive ablation? Preoperative or postoperative chemotherapy should be taken into full consideration based on the patient’s disease and its stage, the patient’s general condition and mental state. This is referred to as individualized treatment on the overall level. Even minimally invasive ablation could be applied but would still depend on the specific circumstances, closely considering cryosurgery, radiofrequency, ethanol injection, or microwave, ultrasound and so on. Some people say that doctor is a skilled worker just as a carpenter, mason or tailor.
Experience is also very important for a doctor, which is reflected in the judgment and application of an individualized treatment.
Currently individualized therapy refers to the molecular level one. Gene/protein expression analysis can predict the following four results of different patients with the same cancer: 1 toxic but effective; 2 toxic and noneffective; 3 non-toxic and noneffective; 4 non-toxic but effective (Figure 13).
Drug selection is based on the testing of target spot chemotherapeutic drugs to avoid ineffective harmful chemotherapy, save valuable treatment time and reduce side effects. For example, mRNA expression level test for ERCC1 / RRM1 / TYMS / TUBB3 etc in the cancer tissue can predict patient’s responses to platinum/gemcitabine/fluorouracil/antimicrotubule drugs and other common chemotherapeutic drugs.
Individualized therapy has great success in lung cancer treatment. The targeted drug Gefitinib is effective in non-small cell lung cancer, but it is not suitable for all patients. The efficacy of the drug for Caucasians is far poorer than for the Asians, the key is whether there are EGFR mutations and K-ras mutations. The female Asian patient with adenocarcinoma who is a non-smoker and especially an EGFR mutation carrier is sensitive to Gefitinib.
Concerning breast cancer, except for the applicable principles of surgery, whether estrogen receptors are positive and Her-2 expression is excessive, the therapeutic programs are completely different. An appropriate therapeutic program will directly affect the patient's prognosis.
It is quite difficult to determine clinically whether a patient needs chemotherapy. After the primary tumor is removed, administering chemotherapy, radiotherapy or other treatments mainly depends on whether there is tumor metastasis. The larger the tumor is, the higher the possibility of metastasis. Take breast cancer for instance, if the size of the primary tumor is less than 2 cm, 80% of tumors will not spread to body parts. If the size is up to 3.5 cm, the possibility of metastasis will reach to 50%; while if the primary tumor is up to 10 cm, the possibility of metastasis will reach to 85%. Those cancers that relatively sensitive to chemotherapy (such as breast cancer), the smaller the metastatic tumor is, the better the effect of chemotherapy is. Under the circumstance that the patient had been predicted to have the possibility of metastasis, but clinical and imaging diagnosis cannot find any obvious tumors, chemotherapy works best. Currently genetic analysis can achieve this objective. For example, with colorectal cancer patients, the mutation rate of K-ras gene is 30% to 35%. If the
K-ras gene mutation occurs, the clinical use of EGFR drugs (such as Erbitux) will be ineffective. If the patients have these kind of chemotherapeutic drugs, not only will they be ineffective, but also cause side effects to patients, and spend huge amounts of money in vain.