If a few years ago the possibilities for treating cancer were limited to chemotherapy and radiotherapy, these techniques – which destroy cancer cells, but also damage healthy cells – are increasingly being replaced by options with less toxicity and more focused on specific characteristics of each patient.
“Increasingly personalized therapy options make cancer closer and closer to becoming a disease considered chronic, with effective benefits to the quality of life of people diagnosed with the disease”, says oncologist Bruno Ferrari, founder and president of the Board of Directors of the OncoclÃnicas Group.
In the expert’s opinion, the future of the treatment of the disease is promising, and will allow more and more people to have therapeutic options with fewer side effects and more encouraging prognoses.
Genomic analysis is the basis for individualization
Advances in studies involving the human genome, in addition to the genetic code present in tumor cells and uniquely in each individual, have made gene analysis an indispensable part of this area of ​​medicine in recent years.
Doctor José Cláudio Casali da Rocha, head of oncogenetics at the ACCamargo Cancer Center, explains that genetic studies focused on cancer are divided into prevention and treatment, diagnosis and follow-up.
“The first (analysis) is called germline, and is performed on the person’s own DNA. The objective is to define characteristics of individuals, detect a possible greater sensitivity of certain genes to cancerous mutations and also genetic markers, for example. somatic analysis is a genomic analysis of the tumor, made to evaluate the biological behavior of its cells and understand, among other factors, what is the chance of it spreading.”
These genomic studies, according to Casali, require the creation of treatment consensus among different specialists.
“It is no longer a single doctor who defines the treatment today. This decision is shared and discussed with the patient.”
Immunotherapy boosts the body’s defenses
The treatment is done with substances that were developed to identify and attack specific characteristics of cancer cells, blocking tumor growth and allowing the patient’s organism to recover the conditions to defeat it.
The discovery of immunotherapy is what earned immunologists Tasuku Honjo, Japanese, and James Allison, American, the 2018 Nobel Prize in Physiology and Medicine.
Tests with these drugs have shown positive results for cancers such as breast, ovary, lung, head and neck, bladder, melanoma, among others.
Therapies that use immunotherapy are also proving to be increasingly effective, and this is good news for the coming years – the expectation is that the technique will become more popular in terms of knowledge and application, in addition to being cheaper.
In the Unified Health System (SUS), the first immunotherapy available free of charge to Brazilians was approved in 2020, benefiting patients with advanced melanoma.
Although there are already many treatment options, our public health system still faces obstacles due to financial issues.
Monoclonal antibodies: less toxicity and greater effectiveness
Considered a type of immunotherapy, treatment with monoclonal antibodies, also called targeted therapy, helps the body identify cancer cells.
They are produced in the laboratory to bind to a specific target on tumor cells and can either trigger an immune response that destroys cancer cells or mark them, making them easier for the immune system to identify.
Antibody therapies can be combined with chemotherapy.
“What happens, in these cases, is that the combination will take the chemotherapy directly to the cancer cell, focusing the treatment only on it, which reduces the toxicity for the organism, at the same time that it increases the effectiveness of the treatment”, says Carlos Barrios, oncologist at OncoclÃnicas and hematology specialist at the University of Washington, USA.
According to him, it is important to emphasize that, in order to achieve good results with these therapies, one factor is paramount: to know in depth the type of cancer and the characteristics of each patient and each cell, in order to reach the disease more precisely.
“It is necessary to be equipped with technology that identifies genetic alterations in detail. Not many places offer this type of treatment”, he says.
Fever, chills, weakness, headache, nausea, vomiting, diarrhea, reduced blood pressure and skin rashes are some possible adverse effects of the technique.
Liquid biopsy is the least invasive technique to detect and monitor tumors
A liquid biopsy is a test that uses mainly blood (although it can also use urine or other body fluids, such as saliva and cerebrospinal fluid) to look for the presence of cells from a malignant tumor or fragments of DNA from tumor cells.
“The test receives this name to differentiate it from solid biopsy, in which you take a fragment of the tumor and analyze it under a microscope, a more invasive technique”, explains Héber Salvador, oncological surgeon and president of the Brazilian Society of Oncological Surgery (SBCO).
It is possible to assess, for example, the effectiveness of a treatment (such as chemotherapy), and the possibility of relapse (cancer return) in a patient already in remission by analyzing the presence of tumor cells after the end of a treatment.
Despite already being used for other types of cancer, its most frequent current use is in patients with colorectal and lung cancer, since these are the diseases with the most research that reinforce the benefits of the technique.
CAR-T Cell is an alternative for hematological tumors
A new treatment option for hematological tumors – such as lymphoma and leukemia -, also applied through gene therapy, is the so-called CAR-T Cell.
It consists of using the patient’s own cells (T lymphocytes, defense cells) and genetically modifying them in the laboratory to fight cancer.
With the technique, it became possible to equip the body’s defense cells with receptors capable of recognizing the tumor and attacking it in a continuous and specific way.
The high cost of producing the treatment is a concern, but its progress has been encouraging since it gained popularity in Brazil in the second half of 2019.
At the time, a patient with advanced non-Hodgkins lymphoma at the Hospital das ClÃnicas da Faculdade de Medicina de Ribeirão Preto at USP, in the interior of São Paulo, was considered the first patient in Latin America to achieve remission of the disease with the use of CAR cells -T.
The strategy used for the treatment opens up fronts for its use not only in hematological tumors – such as lymphoma -, possibly being used for any type of cancer.
“The methodology already includes research aimed at protocols for acute myeloid leukemia and multiple myeloma. There are expectations that in the near future it will be possible to use CAR-T Cell in solid tumors, such as pancreatic cancer, just to mention one of the possibilities that are already under discussion”, explains hematologist Renato Cunha, doctor from the Faculty of Medicine of the University of São Paulo (USP).
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