Precision medicine for breast cancer demands a multidisciplinary approach, says QF expert

A rapidly growing field in cancer care is precision oncology – that is tailored treatment for patients based on their tumor’s genetic signatures. However, treatment based solely on genetics appear to be unsuccessful for many, indicating that there are other factors involved. The question is: How do we make precision medicine more precise?

“Precision medicine, by focusing on tumor genomic analysis, aims to identify specific treatment targets. However, other components including tumor metabolism, which cannot be directly monitored by genomic analysis, can stimulate cancer cell growth and progression. Much like genetics, metabolism also differs from individual to individual and has the potential to make precision medicine more effective,” said Dr. Anna Halama, Assistant Professor of Research in Physiology & Biophysics at Qatar Foundation (QF) partner university Weil Cornell Medicine – Qatar (WCM-Q).

In a futuristic project funded by QF’s Qatar National Research Fund and Hamad Medical Corporation (HMC), scientists from WCM-Q, Weill Cornell Medicine (WCM) and clinicians from HMC have collaborated to explore the pathology of breast cancer to gain a more precise understanding of the tumor by focusing on its metabolomics in addition to genomic analysis.

Metabolomics is a field of study that measures the complete set of metabolites – products of cellular metabolism within a biological sample to offer a snapshot of a living organism’s health in real-time. Major health factors, including disease, diet, lifestyle and genes, exert their influence by subtly changing our metabolic composition.

“Research and clinical advances are intertwined. I strongly believe projects aiming to advance precision oncology require a multidisciplinary team including surgeons, oncologists as well as computational biologists, each of which bring a unique perspective. The team working on this project consists of Dr. Kulsoom Junejo, Senior Consultant Breast Surgeon at HMC, Dr. Salha Bujassoum, Senior Consultant of Medical Oncology at HMC and Dr. Jan Krumsiek, Assistant Professor of Physiology and Biophysics at WCM.”

It is well-known that cancer cells have different metabolism than normal cells. Their metabolism is heavily influenced by microenvironmental factors, including nutrient availability. Because cancer cells need a lot of energy to fuel their rapid growth, they are not fussy about what they consume to generate energy and use whatever is available in their immediate environment. Therefore, cancer metabolism could serve as a target for novel treatment strategies.

“One of the goals of the project is to define the metabolic profile that characterizes a breast cancer patient. This will be done by performing metabolomic analysis of blood samples from breast cancer patients and healthy patients. A comparison of the two will allow us to establish a metabolomic signature that is typical for a breast cancer patient,” said Dr. Halama.

The second goal is a bit more complicated. In addition to the patient metabolomics, the group is also aiming to study tumor metabolism by determining the metabolic composition of the tumor and its surrounding tissue.

Dr. Halama explains: “Studying tumor tissue metabolomics can help us better understand how the tumor grows and what kind of nutrients it relies on to fuel its growth and how this can be used to optimize treatment.

“In studying tumor tissue, having a fresh tumor sample is very important, this is why Dr. Junejo’s involvement in the project is critical. As a breast surgeon, she is leading our efforts to optimize the tumor tissue collection process.”

Detailed understanding of a patient’s cancer and how their body responds to it is crucial for the improvement of treatment options. A combination of metabolomics with genomics analysis is the way forward in better understanding these processes and putting us one step closer to realizing the vision of precision medicine.

“If we know how a patient’s cancer is fueling its growth, we can try to intervene with more precise therapies than we have used in the past. Information obtained from metabolic dysregulations identified in the blood has the potential to support early cancer detection and evaluate response to treatment.”