Dr. Shunyakov on the Impact of Genomics on Personalized Therapy in Oncology

Leonid Shunyakov, MD, hematologist/oncologist, Central Care Cancer Center, discusses how genomics have impacted personalized therapy in oncology.

In addition to using tumor mutational burden, gaining knowledge at the molecular level about how genes work and using that knowledge to guide therapy is another novel way of using next-generation sequencing (NGS), says Shunyakov. In kidney cancer, one of the most commonly mutated genes is PBRM1. It is associated with activation of a certain inflammatory pathway, and whenever it is activated, there is a higher likelihood of response to immunotherapy.

However, NGS is not the answer to everything, explains Shunyakov. In addition to NGS, physicians have proteomics. Exosomes are produced by cancer and expulse microRNA. Shunyakov adds that the tumor has a 3D structure which is why there is tumor heterogeneity. Solid biopsies may not reflect everything. To get a more complete picture, physicians may use the combination of liquid and tissue biopsies.

There is also a very important role for the microbiome, states Shunyakov. At the 2018 ASCO Annual Meeting, physicians learned that akkermansia bacteria are associated with marked improvement in response to immunotherapy, and certain bacteria such as bacteroidetes are associated with “cold” immune signatures and lower responses to immunotherapy.