The Future of Cancer Therapy: Personalized Medicine
The news was devastating. Sasha only recently developed a chronic cough and shortness of breath, and here she was staring blankly at the wall, phone loose in her hand. Her primary care physician called to review the imaging and tests ordered to diagnose the persistent lung symptoms. Sasha was in her 30s and never smoked, so her doctor’s suspicions were justified. Aside from the respiratory symptoms and mild fatigue, she felt fine. She didn’t hear much else after her doctor suggested a tentative diagnosis of non-small-cell lung carcinoma.
She did recall her doctor’s recommendation, “I’m going to refer you to an integrative oncologist colleague who specializes in lung cancer. She’s out of the area, but you can set up your initial evaluation with her through the online portal and we can administer her treatment protocol here in network.”
Sasha had a good relationship with her primary doctor, so she trusted her referral. She initially found it odd that the referral wasn’t in her medical system, but her doctor knew Sasha well and understood that she preferred a more holistic approach. That a local oncologist would be in close contact with this out-of-state integrative provider was a relief. After hearing the diagnosis, her initial concern was being sick from chemotherapy, but the cost of treatment also kept her up at night. Treating in network would cover drug costs, with her only out-of-pocket expenses being the occasional check-in with the integrative oncologist.
“Hi Sasha, I’m Dr. Stevens, but you can call me Julie,” greeted the integrative oncologist during their initial contact. “I’ve spoken with your local oncologist, Dr. Philip, and he was very willing to take a personalized approach to your care based upon my research with non-small-cell lung carcinoma. He and I will continue to be in touch, but you’re always welcome to contact me with questions or concerns.”
“Thanks, Julie,” replied Sasha. “Dr. Philip seemed quite knowledgeable and confident administering the standard of care, but he also honored my choice to get a second opinion from you. I’m curious how your treatment protocol differs.”
“That’s an excellent starting place,” said Julie. I’ve received the report from the genetic testing Dr. Philip ordered on my behalf. To individualize your care, we need to understand the context in which this cancer developed. In your case, you have a gene deletion and an SNP mutation that makes you more sensitive to drugs. Looking over your intake forms, this explains your reported chemical sensitivity and why caffeine makes you jittery. I can understand why you’ve been nervous about the chemotherapy protocol that Dr. Philip described. We have had excellent outcomes with that drug combination, but the side effects do impact adherence to the full course of treatment.”
“Yes, Dr. Philip mentioned you had a gentler approach that did not compromise efficacy. Is that true?” hoped Julie.
“I’ve worked with a lot of patients who share your concern and I can assure you that an integrative approach does just that,” said Julie. “Successful treatment pivots on sensitizing the cancer cells so that we can use the minimum effective dose of the chemotherapy drugs. We do this while supporting healthy cells to minimize side effects.”
“The day prior to and day of your weekly chemotherapy, I want you to be fasting—water only. This beneficial stress will turn on protective genes in your healthy cells that the cancer ones don’t have. You’ll be hungry, but it will be worth it. I’ve also matched up your drug regimen with the constitutional workup and have determined that the best time for your infusion is midday. This is called chronotherapy, and it allows us to further lower the chemotherapy dose following the rhythm of your body. The cancer cells will be most susceptible then, and we will pair that with an intravenous check point inhibitor drug to activate your immune system.”
“I’ve heard about research into that drug and my type of cancer,” said Sasha. “Is that the immunotherapy part of your protocol?”
“That’s one aspect,” said Julie. “I’ve also conducted a lot of research on hyperthermia to maximize response to treatment. We’ll use a full-spectrum infrared heating array over your chest during treatment to further the effectiveness of the protocol. All this, in combination, will allow us to use the minimum effective dose of the chemotherapy regimen.”
“I’m grateful for the gentle approach, yet I’m equally as concerned about the effectiveness of the treatment as I am the side effects,” said Sasha. “Have these individualized approaches been studied?”
“What you have to understand is that the best doctors always make changes based upon their patient’s response,” replied Julie. “This is the art of medicine, and all we are doing here is taking the standard of care—identified from clinical research—and making it work best for you. Dr. Philip will keep a close eye on you and track your progress with follow-up scans. Instead of the high-dose induction chemotherapy, we will start with a gentle, but targeted approach and increase the drug potency if needed. We have time.”
Sasha signed off from the telemedicine call with relief and focus. She had a clear way forward and a team of caring doctors monitoring her. This would be a difficult journey, but far easier than it would have been without an individualized approach.