Personalized Treatment
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What sets our Medical Oncology Department apart is an innovative strategy: having our own molecular oncology laboratory which works hand in hand with our clinical specialists, entirely devoted to achieving a better understanding of cancer. These investigations have led to the identification of “genetic fingerprints” for the cancerous cells which allow us to select the most appropriate treatment for the patient.
The goal is to achieve personalized treatments according to the genetic characteristics of the disease.
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Lung cancer
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Treatment with oral drugs (pills)
Lung cancer is the leading cause of death from cancer. Today, non-small-cell lung cancer (NSCLC) can be classified into various types according to genetic alterations/mutations found in the tumor tissue. Targeted personalized treatments effective against these alterations/mutations can be administered for each of these subtypes. What follows is an explanation of two kinds of tumoral genetic alterations, and two very targeted/specific oral treatments (in the form of pills) effective against them.
Firstly, mutations in the EGFR gene occur in 16% of the Western population, most frequently in women, non-smokers, Asians and lung adenocarcinomas. The presence of these mutations predicts response to a targeted treatment known as an EGFR tyrosine kinase inhibitor (some examples of drugs currently available are Iressa® or Taceva®). Several trials have demonstrated that administration of this treatment in patients with non-small-cell lung cancer bearing EGFR mutations in tumoral tissue improves survival and maintains a good quality of life. Notable among such trials is one designed by Dr Rafael Rosell, the results from which were published in the New England Journal of Medicine in 2009, in which these mutations were analyzed in over 2000 Spanish patients.
It has also been discovered that between 2 and 7% of non-small-cell lung cancer patients have another genetic alteration which is a reorganizing and fusion of two fragments of chromasome 2 (ALK and EML4). This is more common in male patients, the young, non-smokers and those with histology of adenocarcinoma (occurring in up to 44.8% of cases in these subgroups of patients). The oral treatment Crizotinib® inhibits this genetic alteration, prolonging survival for these patients. It is important to note that these new treatments are taken orally, are very targeted and, therefore better tolerated, with less of the side effects associated with traditional chemotherapy.
What does this mean for me?
- If you have lung cancer, tests may be warranted to determine if you carry either of the mutations described above.
- If you do have a mutation, you may be eligible to receive an innovative personalized treatment, taken orally, effective and with few side effects.
At the Oncology Institute Dr. Rosell, our molecular biology laboratory works closely with our expert lung cancer oncologists, Dr Rafael Rosell, Dr Amaya Gascó and Dr Santiago Viteri, averaging a turnaround of just 5 working days for delivering test results. This means we can quickly evaluate the possibilities of recommending an oral treatment for lung cancer.
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Breast cancer
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Radiotherapy by MammoSite
The earlier breast cancer is diagnosed, the better the chances are of surviving the disease. There have been important advances over the past few decades in techniques for detecting breast cancer, making breast conservation surgery, i.e. a lumpectomy rather than full mastectomy, increasingly feasible. After a lumpectomy, treatment with radiotherapy is required to eradicate possible residual tumoral cells in order to avoid local recurrence of the disease. Traditionally, this treatment is administered through 33 daily sessions spread over a period of 6 to 7 weeks, during which the whole mammary gland is irradiated. This means that a larger area than that of the original tumor is exposed to radiation, implying damage to both healthy tissue and the surgical site itself.
Following lumpectomy surgery, the MammoSite technique allows, in very specific cases with very good prognosis, for a much less aggressive form of radiotherapy to be administered. MammoSite involves partial irradiation of the breast, concentrating on the area where the breast cancer was detected, and is a more targeted treatment involving the same biological dose as conventional external radiotherapy, but divided into larger doses per session and delivered over a period of just 5 days.
How does the MammoSite applicator work?
During surgery, a catheter with a small inflatable balloon at the end is placed inside the cavity left by the lumpectomy. The radiation treatment, which is planned by a radiation oncologist, is administered by passing radioactive material down the catheter and into the balloon. This process is repeated twice a day for 5 days, 10 treatment sessions in total. After the last treatment the catheter is emptied and removed.
What are the benefits?
Obviously delivering radiotherapy via the MammoSite technique means less breast tissue is irradiated, and the patient is able to return to their normal life again much sooner. Side effects are also less severe and are experienced over a much shorter period.
In our center we have doctors who are highly experienced in the treatment of breast cancer, such as Dr Maria Gonzalez Cao and Dr Jaume Fernández Ibiza, and who can assess the possibility of offering radiotherapy with MammoSite to those patients who could respond well with this technique.
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Cáncer de estómago
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There are no translations available. Análisis de HER2+
Recientemente han habido avances relevantes en el tratamiento del cáncer de estómago diseminado, como la identificación de la sobreexpresión (aumento de actividad) del gen receptor del crecimiento epidérmico (HER2). Entre un 20 y un 30% de pacientes que padecen de cáncer de estómago muestran sobreexpresión del HER2 y se ha visto que la combinación de tratamiento personalizado de quimioterapia con Herceptin® mejora de forma significativa la supervivencia de estos pacientes quienes, por lo tanto, predicen una respuesta de beneficio clínico con el uso de esta terapia dirigida. Para la selección de este tratamiento, se requiere de un análisis complejo de la sobreexpresión del HER2, lo cual realizamos en el Instituto Oncológico Dr Rosell.
Tratamientos personalizados como Herceptin® para el cáncer de estómago sólo están disponibles en centros especializados, tanto a nivel clínico con profesionales expertos como la Dra. Amaya Gascó, como a nivel molecular/genético donde cuentan con un laboratorio de biología molecular para el análisis de biomarcadores genéticos de selección (como HER2, BRCA1, RAP80). El análisis de estos biomarcadores permite individualizar el tratamiento para cada paciente, aumentando así las posibilidades de éxito del tratamiento seleccionado.
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Cáncer de colon
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There are no translations available. Cirugía peritoneal
Un porcentaje importante de los canceres colorectales se manifiestan con carcinomatosis, es decir, la presencia de nódulos tumorales diseminados a lo largo de la cavidad abdominal. En nuestro centro aplicamos un tratamiento quimioterápico personalizado de la carcinomatosis basándonos en las propias alteraciones genéticos individuales de cada paciente, así como la incorporación de terapias con nuevos anticuerpos monoclonales (Erbitux®, Avastin®, Vectibix®) seleccionados según las variantes genéticas de cada paciente, como mutaciones en el gen K-RAS BRAF, P3K o PTEN.
Con posterioridad a este tratamiento personalizado se debe realizar la cirugía citoreductora peritoneal. La cirugía citoreductora es la resección completa de todos los nódulos peritoneales que se encuentren en la intervención quirúrgica, con la intención de eliminar toda la enfermedad metastásica, lo cual permite un tratamiento con intención curativa en casos muy seleccionados. La cirugía citoreductora peritoneal sólo se puede realizar en centros que dispongan de un equipo quirúrgico muy experimentado, así como oncólogos médicos de gran experiencia como nuestra experta en el campo de cáncer de colon Dra. Amaya Gascó.
Cirugía de las metástasis hepáticas
El 40% de los pacientes con cáncer de colon debutan con metástasis hepáticas, y más de la mitad de los pacientes operados de neoplasias de colon desarrollarán en su evolución diseminación en el hígado. La mayoría de estos pacientes precisarán de tratamiento con quimioterapia, acompañado de terapias dirigidas (anticuerpos monoclonales como Erbitux®, Avastin®, Vectibix®). A día de hoy, en nuestro centro disponemos de marcadores genéticos, como las mutaciones del gen KRAS, BRAF, P3K y PTEN para la selección de estos tratamientos, por lo que aumentamos la efectividad de la terapia con un tratamiento personalizado para cada paciente.
Al conseguir reducir el tamaño de las metástasis hepáticas, se aumenta el éxito de la cirugía de las lesiones hepáticas, y por consiguiente las probabilidades de supervivencia. En cuanto a la cirugía hepática y el tratamiento de estos pacientes, se requiere de un equipo multidisciplinar y experto en cirugía de las metástasis hepáticas con el fin de hacer una resección completa de las lesiones. La cirugía de las lesiones hepáticas no es común a nivel de todos los centros hospitalarios dado que precisa de personal experimentado, tratamientos innovadores (quimioterapia, anticuerpos monoclonales) y una integración entre cirujanos y oncólogos que no se encuentra en todos los hospitales. En el Instituto Oncológico Dr. Rosell disponemos de la Dra. Amaya Gascó y personal con gran experiencia en el tratamiento de cáncer de colon con metástasis hepáticas, con la incorporación de las últimas innovaciones en este campo.
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