Cancer is a complex condition that must be treated. Some people respond better to some treatments than others, and much of your treatment depends on when you were diagnosed, where your cancer originated from and how far it has spread.
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When we start talking about rare or aggressive cancers like cholangiocarcinoma (bile duct cancer), this is especially true – there’s still a lot we don’t know, and Navigating misinformation It can be difficult.
But with the help of molecular profiling (also known as biomarker testing), as well as ongoing research and clinical trials, it’s even easier to discover the right treatment for you.
oncologist Sunil Kamath, MDexplains only how molecular profiling works and why you might want to participate in a clinical trial.
What is molecular profiling?
The cells in your body are distinctly different from each other depending on the type of cells. Kidney cells are made up of different molecules than skin cells. Your blood cells are different from your brain cells, and so on. These differences also occur in cancer cells, and each cancer type will have different configurations than other cancers. This is how doctors can find out bile duct cancer different from Liver Cancer Even when bile duct cancer cells are present inside from your liver.
“Liver cancer starts from the actual liver cells, which are called hepatocytes,” says Dr. Kamath. “Bile duct carcinoma is cancer that comes from the cells of the bile duct, and these cells are in the exact same organ as the liver cancer cells. They are next to each other on a microscopic scale.”
There are distinct molecules, called biomarkers (or biomarkers), that distinguish each cell from the other. These biomarkers can be measured in tissues, blood, and other body fluids through the process of molecular profiling (also known as biomarker testing or genetic sequencing). For molecular profiling to work, doctors must take samples from the site of the tumor or the origin of the cancer. This is often done with a file biopsy. Doctors can do this when determining your initial diagnosis through a tissue biopsy. Or they can do a liquid biopsy (blood test) to measure something called cell-free DNA, or tumor circulating DNA. This is the DNA that the cancer has thrown into the bloodstream. This type of test can be done for several different types of cancer.
There are three classes of biomarkers, and each class tells doctors different information about the cancer they are looking for:
- Diagnostic biomarkers Telling you if you’ve had cancer and where the cancer comes from. These biomarkers are the way doctors can use them gallery test To capture more than 50 types of cancer in one simple blood test.
- Prognostic vital signs It tells you how long people live with this type and stage of cancer on average, how bad your cancer is and how likely your cancer is to return after treatment is finished.
- predictive biomarkers It tells you which treatments might work best for your specific cancer in your specific case.
“Biomarker testing is a strategy for us to look for something potentially targeted beyond our standard treatments such as chemotherapy or immunotherapy, which are often given to all patients regardless of specific biomarkers,” says Dr. Kamath.
How does molecular profiling determine your level of care?
Everyone is different. for some people, Chemotherapy It might be really effective. For others, a combination of chemotherapy and Immunotherapy It will work better. and for others, Targeted therapies Designed to target specific genetic mutations found in cancer cells with the goal of reducing damage to other healthy cells in your body.
About 30% of people with cholangiocarcinoma have a known biomarker, which means that about 30% of people with cholangiocarcinoma have a direct pathway toward targeted therapy.
“For cholangiocarcinoma, there are quite a few genetic targets that we’ve found over the years,” notes Dr. Kamath. We are looking for specific genetic or genomic targets. There are individual drugs developed that can target those exact mutations.”
Currently, there are three targeted therapies approved by the U.S. Food and Drug Administration (FDA) for people with . NTRKAnd the FGFR And the invigratinib genetic mutations. There are also three biomarkers that respond well to immunotherapy.
“The gene mutation known as microsatellite instability (or MSI-H/dMMR) is really sensitive to immunotherapy,” Dr. Kamath explains. “This mutation or biomarker is only present in 1% to 2% of people with cholangiocarcinoma, but is important for those people with it. A high tumor mutation burden (TMB) is another biomarker that can indicate further susceptibility. Immunotherapy. PD-L1, a common biomarker for immunotherapy in other cancers, has a less proven value as a biomarker in cholangiocarcinoma. And we learn more and more about the other goals over time.”
What if you don’t have any known vital signs?
Of course, there is a possibility that you will not have any known biomarkers that will indicate to doctors the most effective treatment.
“If you don’t have any vital signs, it doesn’t automatically mean you’ll do worse,” says Dr. Kamath. “If we don’t have a drug for a gene that works really well, it is possible that the results may not be good. But the absence of a biomarker does not necessarily mean that the tumor has become more aggressive or that there are no treatment options. In these cases, we may use options Standard treatment such as chemotherapy, immunotherapy or a combination of the two.”
Regardless of the outcome, participation in molecular profiling or biomarker testing is critical to understanding your prognosis and what is possible. With each test performed, doctors continue to learn more about the nature of the cancer, how it spreads, and how to prevent it from spreading.
“If people are interested in making sure that they are going to no effort, testing vital signs is really important because we never find anything that we’re not looking for,” says Dr. Kamath.
Should you participate in a clinical trial?
One thing that you might want to consider, especially if you have dynamic selectors defined, is the option to share a file Clinical trial Where doctors can treat you with new and advanced treatments that can have better results than existing medications.
And if you’re concerned about participating in a study that gives some people a placebo or no treatment at all, you don’t have to worry about participating in a cancer clinical trial: Everyone who participates in a cancer clinical trial is provided at least the standard treatments they would have had if they had not joined the Experience in the first place. Many will also get a new clinical trial drug that could be more effective against cancer.
“All of these drugs take several years from the time they were first produced or identified to become approved by the FDA,” says Dr. Kamath. “A clinical trial is a way to get to those treatments before others can. Often times, these tend to be significantly more effective than current standard treatments.”
Dr. Kamath is currently piloting a clinical trial looking at the effectiveness of a particular drug Objectives FGFR2 In patients with cholangiocarcinoma and other tumors. FGFR2 It is a specific gene belonging to FGFR family. Current FDA-approved drugs target the entire system FGFR family, which can lead to unnecessary side effects. But if Dr. Kamath’s clinical trial is successful, it may shed light on a new targeted treatment that is potentially more effective for people who have the exact treatment. FGFR2 Mutation – approximately 10% to 15% of people develop cholangiocarcinoma.
“I would encourage anyone with cholangiocarcinoma to have a vital sign test to help tailor their care to their specific condition,” says Dr. Kamath.