Which tumors can be considered for a molecular-based personalized therapy ?
Personalized omics-based diagnosis and therapy is experimental today. Worldwide service facilities are slowly emerging.
Tumors for which a proven and standard therapy is available should always receive this standard first. For newly diagnosed glioblastoma radiation and concomitant chemotherapy with Temozolomide followed by adjuvant Temozolomide is a well-established standard therapy. However, first emerging reports in the literature suggest a combined standard therapy with omics-based therapies.
Until more detailed data become available omics-based therapies should only be considered for tumors with limited or no treatment options such as recurrent glioblastoma, recurrent astrocytoma WHO grade III, anaplastic meningioma WHO grade III and other rare brain tumors.
The 4D analysis considers the evolution of dominant molecular mechanisms from newly diagnosed and untreated tumors, and at time of tumor resistance and progression, and recurrent bulk tumor. To get the most complete information on the individual tumor this analysis should incorporate as many as possible tumor samples from different regions and different cellular components if possible.
This, if possible, requires biopsy tissue specimens from the first operation of a glioblastoma and specimens from operation or stereotactic biopsy of the recurrent tumor. Both biopsies from microsurgical operations and stereotactic biopsies are sufficient for omics-analysis, because the amount of tissue required is very small.
Different from routine procedures the tissue samples should be snap-frozen in liquid nitrogen (-180° Celsius) to preserve the genetic information as good as possible. The samples may be stored at -80° Celsius for as long as needed and can be transported on dry ice. The omics-based analysis can be performed at any time a personalized therapy is considered.
What is required for a 4D analysis of a recurrent glioblastoma ?
If no biopsy is available from operation of the primary tumor, omics-based analysis as well as personalized therapy of the recurrent tumor is still possible. If only a snap-frozen single sample of only one tumor region is available a personalized therapy remains possible. But such material may not fully represent the entire tumor and the power of the prediction of a genome-wide analysis is not as strong.
If no frozen tissue, but only routine samples of paraffin embedded tissue for histology is available, the molecular information (RNA) may not be well preserved. However, depending on the quality of RNA in those samples omics-based analysis may still be possible.
Because of these requirements it is extremely important to plan and discuss the kind and number of samples and times of collection with your physician in detail.
If no samples are available, is a molecular-based individualized therapy still possible ?
The bioinformatic analysis searches for molecular characteristics which may be suitable for a therapeutic attack. For this the software simulates the effect of approved anti-cancer agents from all field of oncology, not only glioblastoma. For those compounds the mechanism of action and side effects are well known, but they may have never or rarely been tested in Glioblastoma.
To which degree an individual tumor may depend on the identified pathways and candidate targets can only be concluded from the simulation by the software for 4D analysis. The actual effectiveness of any identified compound, as in all other treatment strategies, depends on a multitude of individual facts.
Further, any identified drug candidate has to be very carefully evaluated before given to a patient. Individual risk factors, concomitant medication, other medical conditions, and specifics of the individual glioblastoma disease have to be considered.
What are the possible results of an omics-based diagnosis and which therapies will I get ?
Questions and Answers
Can I get omics-based diagnostics and personalized therapy today ?
Omics-based diagnostic and deduced personalized therapy currently are only available at few research centers with a special interest and are not readily available. However, the methodology of next generation sequencing and bioinformatics analysis is globally available at costs that now approach routine diagnostics. The individualized therapy using compounds of highest drug scores predicted and adapted to individual risk factors, concomitant medication, other medical conditions, and specifics of the individual glioblastoma disease can be done by any oncological site near to the home of the patient.