Biomarkers offer a glimpse into the future of personalised cancer treatment

Dr Irene Chong in her laboratory at the ICR (photo: Katie Hyams) 

A biomarker is a biological measure that can be used to detect or monitor a feature of cancer, such as whether it has progressed or if it is likely to respond to treatment.

Various measures can be used as biomarkers, including genetic mutations, proteins produced by tumours, or physical or biological changes detected on a scan.

At The Institute of Cancer Research, London, we lead the way in this type of research because our excellent translational research facilities enable us seamlessly to take the discoveries that we make in our in the laboratories to patients in clinical trials.

At the Drug Development Unit — a joint unit of the ICR and The Royal Marsden NHS Foundation Trust — we have had great success in using biomarkers to drive clinical trials that investigate new cancer treatments.

Thanks to our National Institute for Health Research Centre for Molecular Pathology, we are able to increase the success of these trials by genetically profiling patients’ tumours to pinpoint those who are most likely to respond to new therapies.

This kind of research is already delivering huge improvements for patients and is opening up new, unexplored avenues for treatment. We have started selecting patients for different therapies on an individual basis, according to what is likely to be most effective for them. The next step will be to understand how and why patients develop resistance to treatment that worked initially.

Detecting drug resistance

We are also working hard to develop robust clinical assays that can detect biomarkers circulating in the bloodstream. We hope that these ‘liquid biopsies’ can eventually reduce the need for multiple, invasive tumour biopsies. If we can pick up early signs of drug resistance, it should be possible to rapidly switch patients to an alternative treatment.

Trials that include the use of biomarkers can identify patients who are particularly likely to respond to treatment due to features specific to their cancers.

Photo: Jan Chlebik/ICR

Using biomarkers, we can assess whether a treatment is likely to work in a patient, analyse tumours during treatment to monitor any changes, identify mutations that can be targeted at each stage of a patient’s disease and pick up early signs of drug resistance. Ultimately, we want to adopt a personalised approach to treatment that will reduce side-effects and prevent patients from being given ineffective therapies.

We use biomarkers in many of the clinical trials we run, particularly in early-phase trials of innovative treatments.

For example, in collaboration with AstraZeneca, we are investigating a drug called nAZD4547, which inhibits the FGFR pathway – a signalling system that helps drive cancer. We are studying its effect specifically in patients whose tumours have an overactive FGFR2 gene.

Great potential

Another trial involves treatment strategies that target tumours without active ATM genes, which play a role in DNA repair. We are also researching novel ways of treating cancers that have overactive HER2 and c-MYC genes, which make cells grow and divide in an uncontrolled manner.

Biomarkers offer the potential to benefit patients in so many ways, from advancing diagnostics and treatment to enabling a better quality of life by reducing the need for biopsies.

They are very much a part of the future of cancer treatment.

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