Why functional cancer profiling has the potential to transform patient outcomes on a global scale

The advancement of cancer treatment has arguably been one of the greatest successes of modern medicine, and yet oncologists are still often relying on trial and error to determine the most effective drugs for each patient.

With more than 100 chemotherapy drugs and 300 anti-cancer treatments approved by the FDA alone, patients are all-too-often faced with the prospect of trialling multiple options before finding a drug which effectively stabilises or shrinks their specific tumour.

Whilst this may mystify the general public, with reports emerging that the amount of time and money spent on cancer research should have resulted in ‘a cure’, medical professionals of course understand that the many ways in which each type of tumour can mutate presents an ongoing challenge – and that there is not, and will never be, a single ‘cure’.

That is why functional cancer profiling is such an important step forward in the progress of oncology treatment, with the potential to transform patient outcomes on a global scale.

Function precision oncology

This groundbreaking approach allows scientists and oncologists to test how different cancer drugs work directly on patient’s own cancer cells. By measuring how well the cells survive when exposed to various treatments, one can accurately predict which drugs are most likely to be effective. Even more promising, new platforms are being developed that can forecast whether a treatment will cause the cancer to progress, remain stable, or go into remission for that individual patient. This marks a shift from broad, population-based predictions to truly personalised insights, making it possible to test and select the most effective drug for each patient.

For those who face the gruelling process of experiencing side effects of drugs without a guarantee that the specific medication will assist in shrinking their tumour, this represents a monumental step forward. Instead, the ‘trial and error’ aspect of treatment takes place in a laboratory, with multiple drugs being trialled concurrently on accurate replicas of the patients’ tumour.

The beneficial outcomes for the patient are clear: alongside the avoidance of ineffective treatments being given and unnecessary side effects associated with these treatments, functional precision oncology allows for a much more streamlined timeline: within as little as three to four weeks following a biopsy, a patient can begin receiving a personalised medication regime.

For oncologists, the real advantage lies not in starting treatment sooner, but in getting to the right treatment faster. Without FPO, patients may begin therapy quickly ,but often cycle through several ineffective drugs before finding benefit — losing valuable months and enduring unnecessary side effects. By front-loading testing in the lab, FPO can shorten the time patients spend on ineffective regimens, reduce avoidable toxicity, and improve overall time-to-benefit.

Whilst patient outcomes will always remain the ultimate priority when it comes to healthcare, the costs associated with cancer treatments must also be considered carefully to identify the value of specific methodologies and guidelines. Figures cited in a paper published in The European Journal of Health Economics estimate 375,000 cases of cancer diagnosed each year in the UK, and a spend of approximately £6.7billion in 2012/13 in England alone – a figure expected to grow by 9% each year as prevalence increases, driven largely by an ageing and increasing population.

Thus, the reduction in spend on drugs that ultimately have little or no impact upon a patient’s tumour is to be welcomed from both a medical and a financial perspective. This also means avoiding costly downstream utilisation, such as prolonged hospitalisations linked to adverse events or ineffective care.

Functional oncology profiling is also set to support the pharmaceutical industry, helping inform the research and development teams responsible for the creation and testing of new cancer drugs, as well as providing valuable data about efficacy, particularly in cases of rarer types of tumours and specific mutations.

Drugs can now be screened to optimise dosing strategies, and new indications and drug combinations can be explored – all undertaken in a laboratory. While not a substitute for clinical trials, functional precision oncology can help reduce reliance on animal testing, aligning with current FDA priorities to promote more predictive, human-relevant models.

The future of personalised oncology

The progress of oncology medicine has been rapid over the past 15 years: by 2010, ‘trial and error’ treatment was standard and any form of personalised prescribing was almost impossible, with doctors selecting drugs from trial averages.

Throughout the 2010s, the application of genomics allowed for oncologists to select a drug regime based on tumour DNA. Whilst this was a significant step forward, it was only successful if there was a targetable mutation, meaning 90% of patients have still been forced to undergo the prospect of several drug changes before an effective treatment can be found. It is also important to note that genomics is not able to help inform medical decisions where combination treatments are required.

And that’s why functional cancer profiling represents such a crucial next step because, should it be deployed as standard across the world, future generations would benefit from the complete transformation of cancer treatment.

In a world where survival rates differ vastly depending on the type of tumour – from 98% for testicular cancer to just 1% for metastatic pancreatic cancer, according to Cancer Research UK – there are of course other considerations, such as earlier detection rates and the continued campaign of awareness raising among the general public which must remain high on the agenda.

But once a cancer has been detected, the ability to quickly specify exactly which treatment will work is set to have a transformative impact upon oncology, upon the wider world of medicine, and upon each and every patient who stands to benefit from functional precision oncology.

About the author

Jens M. Kelm, PhD, is co-founder & CSO of PreComb. Kelm is a pioneer in the field of 3D microtissue culture technology and was one of its early developers. As the founder, president, and CSO of InSphero AG, he helped commercialise some of the earliest physiological 3D models, assays, and screening concepts. He also co-founded the Swiss competence center for 3D cell culture technologies (TEDD) and is a member of the steering committee for the 3DCC conference series, organised by DECHEMA. With over 50 publications and 11 patents in the field, Kelm holds a PhD in Biotechnology from ETH Zürich.