Is there personalized medicine in Russia
Know how to treat
Nadezhda Markina "Newspaper.Ru»Personalized medicine has become one of the trends of the outgoing year.
"Newspaper.Ru" figured out whether Russian patients can count on being treated "not under one comb".
Different portraits of the same diseaseIn medicine, there are two approaches – to treat the disease or to treat the patient.
If you follow the first approach, then all patients with the same diagnosis can be prescribed one medicine. The second approach was professed by Hippocrates, and if you follow it, everything is much more complicated, because people are different and the same disease can be caused by different breakdowns in the body. Personalized treatment is an individual tailoring to measure. Although, of course, this is a very rough comparison.
The idea of personalized medicine began to be realized simultaneously with the development of methods of molecular genetic testing. It was then that it turned out that the same disease in different patients can have its own genetic portrait made up of different mutations. From here it becomes clear why, with the same diagnosis, the same treatment helps some patients, while others do not. This is especially true for oncological diseases, because cancer is always a genetic disorder that the cell cannot fix.
Standard chemotherapy is the poisoning of tumor cells with toxic drugs in the expectation that they will get more than healthy ones, because cancer cells have an increased metabolism. But healthy people also get it: from here there are severe side effects. By manipulating the doses, doctors are teetering on the edge to kill the tumor, but keep the patient alive.
Now there has been a paradigm shift in oncology. Oncologists are gradually moving from treating all patients, for example with breast cancer or lung cancer, with the same chemotherapy, to treating them personally and purposefully. Treatment depends on what kind of genetic breakdowns have occurred in patients.
Targeted or targeted therapy is a targeted effect on key biochemical pathways. Drugs for targeted therapy are not suitable for all patients, but for groups of patients with the same mutation.
There are medicines, but where are the patients?Medications for personalized medicine include, for example, monoclonal antibodies.
They bind to certain receptors on the surface of tumor cells and block their vital activity or reproduction. Another promising class of drugs are tyrosine kinase inhibitors: small molecules that suppress the activity of tyrosine kinase, a key enzyme of many signaling pathways in the cell.
But in order to use these drugs correctly, you need to know which patients they can cure: only those who have a certain mutation. And to find such patients, it is necessary to conduct molecular genetic testing.
"Since there are medicines, you need to know what kind of patients," he told the newspaper.Ru" Professor Sergey Tyulyandin, Head of the Department of Clinical Oncology of the N. Blokhin Russian Research Center, Chairman of the Russian Society of Clinical Oncologists. "Unfortunately, it so happened that the state, having registered these drugs and purchasing them for patients, does not finance tests to determine mutations."
According to him, medicines are available, but doctors do not know if there are suitable patients for them. To understand this, it is necessary to organize a program of molecular genetic testing.
Most regional clinics and cancer dispensaries do not have laboratories that can conduct molecular genetic tests. The solution to the problem lies in the organization of "collective use" laboratories that could work nationwide. Thanks to the appearance of such laboratories, any oncologist from any region can do this if he wants to test his patient.
He needs to register on the website, enter patient data into the database and deliver a patient's biopsy sample to the nearest laboratory working under the program through a courier service. After 5-6 days, an answer will appear in the database, which only this doctor sees, about the genetic portrait of his patient's cancer. All this is completely free.
Tumors are "dumb" and "smart"Of course, not every cancer can be "figured out" today, and not every one has a targeted drug.
Oncologists jokingly say that there are "dumb" and "smart" tumors. It's easier with "dumb" ones – they have a key mutation, it's called activating. It leads to the activation of certain proteins and receptors. As a result, cancer cells begin to multiply rapidly and increase their resilience.
The activating mutation is not always possible to determine: in some cases of cancer, the genome is severely destroyed. Today, oncologists already know a lot about key mutations. For example, a mutation of the epidermal growth factor receptor (EGFR) gene is present in 8-10% of lung cancer patients. Every fifth patient has it, and in fact it explains the occurrence of lung cancer in non-smokers. With mutation, the receptor, which includes tyrosine kinase, becomes especially active. Medications block the receptor and interrupt the signaling pathway.
Targeted drugs are also used today for the treatment of breast cancer. There is a group of patients who have HER-2 mutation: it leads to uncontrolled cell proliferation, their stability and increased mobility. And there are effective medications that act only on this group of patients.
The Russian molecular genetic diagnostics program works with several mutations of lung cancer and bowel cancer. For 2.5 years, 15 thousand analyses were carried out. The program is used by 73 regions, 1100 doctors are registered in the database.
In addition to nine laboratories, six more are working in test mode. They have to work for a year before they are accepted into the team. Specialists are not going to increase the number of laboratories too much, so as not to lose quality. But the number of tests conducted will grow.
The reverse side of the coinIn fact, any cancer patient in Russia can undergo genetic testing and find out what kind of cancer he has.
But what to do next with this information? Do patients have the opportunity to be treated according to the "portrait" of their cancer? There should be parallel processes – both determining mutations and improving the availability of drugs.
If the regions know how many patients they have for treatment with a certain drug, they will know how much it needs to be purchased. There is a certain economic justification for access to medicines. And their purchase is assigned to regional budgets. At the same time, the capabilities of the regions, as well as their budgets, vary. The gap in the purchase of drugs between rich and poor regions is enormous.
Obviously, in the near future, the geographical inequality of the regions will continue. In order to equalize access to medical care, it is necessary to increase funding, but, on the contrary, it is being reduced. In the compulsory health insurance system, to which healthcare is now being transferred, the amount of money will also depend on how much money the region will collect into this system. Rich regions will collect more, and poor regions will collect less.
However, the situation with cancer care in the country is gradually improving. In particular, because new equipment was purchased in regional clinics under the healthcare modernization program.
(For gullible optimists: see the note "How Russia buys the most expensive medical equipment in the world" – VM).
Portal "Eternal youth" http://vechnayamolodost.ru26.12.2014