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Dr Marianne Grantham

Head of Cytogenetics and Molecular Haematology
Department at the Royal London Hospital

Clinicians are embracing the power of genomics to help deliver targeted therapies and better treatment options to their patients.

Targeted therapies and a changing treatment landscape based on genomics are offering clinicians the chance to deliver better outcomes for cancer patients.

Speaking on a podcast hosted by Genetics Unzipped, “The Future of Cancer: How Genomics is Transforming Research and Treatment for All”, Dr Marianne Grantham says genomics has an “exciting and important place” in modern healthcare.

She explains there have been huge changes in recent years in terms of the different techniques available, the genetics and the number of cancers where genomics has become increasingly important.

Dr Grantham, who is Head of Cytogenetics and Molecular Haematology Department at the Royal London Hospital, notes that the number of tests being performed, and the cancers that can be tested, is also rising as clinicians embrace methodology such as next generation sequencing.

Treatment options

Her department tests thousands of samples every year from patients with blood cancers, and solid tumours such as bowel, breast or lung cancers, to confirm a new diagnosis, help doctors select the best treatment, or see how disease is responding to therapy.

Rather than just looking at one particular gene or particular mutation, she and her colleagues are now able to look at many different genes at once. “We understand how much more important this information is in the way we manage our patients,” she adds.

That, she continues, means that doctors now have the opportunity to give patients different options based on the genomics. Instead of just using generic treatments, there is now the opportunity to target a patient’s cancer based on genomic information and ensure the treatments are going to work, while also avoiding unnecessary side effects.

Survival improvement

An example is with non-small cell lung cancer, where the treatment landscape has vastly changed as targeted therapies have become available.

Additionally, in haematological malignancies, biomarker specific therapies can enhance patient outcomes and reduce the side effects associated with chemotherapies.

Instead of just using generic treatments, there is now the opportunity to target a patient’s cancer based on genomic information.

“We’re seeing fantastic improvements in patient survival because we’re targeting the cause of that patient’s cancer,” says Dr Grantham. The turnaround time for results has also reduced.

Whereas previously, it could take a month to get a result, now that is possible within a week and possibly between 24 and 72 hours from receipt of sample to a meaningful result, which helps doctors make quicker and better decisions on the treatment options for their patients.

Next generation sequencing

Dr Grantham explains that with next generation sequencing technology, the number of targets that can be tested are not limited. The approach is also becoming more flexible.

Patients can be tested from the beginning of the process, after treatment to make sure that their disease has gone, but treatment can also be adapted if the disease returns or progresses..

She says: “We are doing that a lot already in terms of solid tumours and non-small cell lung cancer, but also in our haematological malignancies. We know that certain cancers develop these resistance mutations and we need to look for them to make sure that we tailor our treatment accordingly.”

Integrating information

As for the future, Dr Grantham believes that it is an exciting time for the field.

She emphasises the value of having comprehensive genomic profiling available for patients in a clinically appropriate timeframe and a clearer understanding of what to do with that information.

But she also highlights how understanding that genomic data in isolation can be meaningless if not integrated with other disciplines within pathology and the patient pathway.

Using it in conjunction with morphology, histology, and immunophenotyping is crucial in order to give the patient the most effective diagnosis and treatment plan going forward.

“I think it’s going to be critical for the future,” says Dr Grantham. “Genomics has a really exciting and important place in a modern healthcare service and Innovations are now making this possible in every regional hospitals.

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