Providing Treatment Unique to Patient's Cancer

In Indonesia, cancer contributes to the epidemiological transition from communicable to non-communicable diseases leading to a double burden of public health problems as a result of an increasing trend in recent years. Colorectal and breast cancer in Indonesia in particular are amongst the top 5 among cancer incidents nationwide. The interesting observations are that 30% of detected cases for both types of cancer are reported in patients under the age of 50. As people in this age group are of productive age, these cancers incur heavy costs and are ranked in the top 2 of national health insurance (BPJS Kesehatan) coverage costs.

As a highly heterogeneous disease, cancer can have diverse genetic and clinical features that influence treatment outcome. Genomic testing can be used to analyze tumor DNA and identify the genetic mutations that are unique to a patient’s cancer. Such analysis can guide the choice of therapeutics, inform on the potential development of resistance to treatments and improve prognosis. Some typical mutations in colorectal cancer include mutations in TP53 gene, which are associated with higher resistance to some chemotherapy, KRAS mutations, which may indicate a better response to RAF or MEK inhibitors, when used in conjunction with PI3K/AKT pathway inhibitors or chemotherapy, BRAF mutations which are associated with a lack of response to anti-EGFR therapy, such as cetuximab and panitumumab. While in breast cancer, the identification of HER2 mutations in cancers that are HER2 amplification negative by other common techniques (immunohistochemistry or in-situ hybridization) can uncover possible drug targets. Identification of BRCA+ mutations often are PARP inhibitors (PARPi). Resistance mutations in ER+ breast tumors potentially identify patients at risk of relapse, providing options for further treatment. Other mutations in 500 genes can help clinicians guide treatment by highlighting potential drug targets or drug resistance and prognosis, as a small percentage of tumors will have rare mutations that may be targetable with specific treatment options.

Vision

• Genomic-driven end-to-end management for colorectal and breast cancers
• Cost efficacious treatment or disease management model to improve survival and quality of life of cancer patients

Disease Target

• Colorectal cancer
• Breast cancer

Outcome

• Rich information of germline and somatic mutations of known genes associated with colorectal and breast cancers from retrospective study
• Seamless systems of hospital-based cancer registry, biobanking, and genomic profiling
• Genomic prognostic or predictive factors of survival that can be used to guide patient treatment