What is personalized cancer care?

LCRP Medical Oncologist Dr. Ajaz Bulbul explains how testing before treatment begins can result in better outcomes for each individual patient

Gone are the days of uniform treatment protocols where every patient with a certain type of cancer at a certain stage got the same treatment. Today, we have personalized cancer care.

At the Nancy N. and J.C. Lewis Cancer & Research Pavilion, our physicians develop customized treatment plans for each individual patient. In medical oncology, several tests are performed before treatment begins to determine the best course of action for each patient.

“Back in the day, a patient would get a standard cocktail of chemotherapy. If they had this cancer at this stage, this is what they get no matter what,” says Dr. Ajaz Bulbul, Lewis Cancer & Research Pavilion medical oncologist at the Liberty Regional Cancer Center in Hinesville. “Now, we study the tumor and the blood to look at a patient’s genetic makeup to decide what kind of treatment would be best for that individual patient.”

First, the oncologist will do an analysis of the tumor, whether it was removed in surgery or through a biopsy. We can read the genetic sequence of all the genes in a tumor, all its DNA and RNA, Dr. Bulbul says, and doctors can examine those genes to determine what’s causing that tumor to grow.

Then, typically a blood test is performed. This can show if there are still tumor cells circulating in the blood and whether or not the entire tumor is gone.

Finally, your doctor will look at your hereditary genetic makeup. This can be done through a family history questionnaire and blood work.

“Then we take all this information and use that to devise a treatment plan,” Dr. Bulbul says. “Instead of, ‘OK, here’s this treatment that may work, let’s get started,’ we get as much information as we can about the cancer and make an informed individualized decision. The outcomes are better.”

Every patient’s results are different. For example, one patient may have a gene mutation that is driving tumor growth. Dr. Bulbul knows there’s a drug that fights off that mutation.

Some breast cancer patients may have tumor cells still circulating in their blood after surgery. Dr. Bulbul knows that means there’s a chance of recurrence so he may recommend chemotherapy. Other breast cancer patients may not have those cells in their blood, so therefore, chemotherapy wouldn’t necessarily be needed.

“Back in the day, almost all women with breast cancer used to get chemotherapy,” Dr. Bulbul says. “Now, far fewer of them will need chemotherapy, and we know that because we can test their tumor, test their blood and get an idea of who will recur and who will not, who needs chemotherapy and who does not.”

“As we get more advanced, we are doing less treatment. Not everyone needs all available treatment. So that’s personalized medicine.”

The results from your tests may also help you make a decision about treatment. Dr. Bulbul says, for example, some patients think once they’ve had surgery, they are done, and there’s no need for chemotherapy. That’s especially true because many people have heard the horror stories that chemotherapy automatically makes you lose your hair and constantly be sick.

That’s not the case with every patient, Dr. Bulbul says. He informs them that treatments have gotten better and that medications to help with side effects also have improved.

Then he shows them tangible results of their tests. If blood work shows residual tumor cells are still circulating, that tells a patient the cancer isn’t completely gone and further treatment is necessary to stop the spread of those cells.

And treatment doesn’t always have to be chemotherapy. Some results may show a patient is a better candidate for immunotherapy or targeted therapy. Results may show you just have to take a pill once a day instead of daily injections or IVs. Treatment options continue to improve, resulting in fewer side effects, shorter treatment sessions and better outcomes, Dr. Bulbul says.

Other areas of cancer care

Medical oncology isn’t the only area of cancer care practicing personalized medicine. Radiation oncology and even surgery have advanced to where there are options to customize treatment for each individual patient.

For example, not everyone with breast cancer has to have one or both their breasts removed. A lumpectomy removes the tumor and cancerous tissue inside the breast, while leaving the rest of the breast attached.

Newer radiation therapy technologies like the CyberKnife® and TrueBeam machines at the LCRP are more precise, saving more healthy cells and tissues around the tumor. There are also different methods and equipment that can be used with these machines depending on the location of your tumor.

“As a whole, we are doing less because what we are doing has gotten so much better,” Dr. Bulbul says. “We don’t have to throw the kitchen sink at you like we used to. Now, we are precise because we know what we are using is effective.”

About our partnership with Liberty Regional Medical Center

The Nancy N. and J.C. Lewis Cancer & Research Pavilion and Liberty Regional Medical Center have partnered to create an oncology program to deliver the latest treatments to Liberty County cancer patients. Learn more on our website.