Personalised medicine
Personalised medicine uses information about a person and their cancer to help with diagnosis and treatment. It is sometimes called precision medicine. Doctors use samples of your blood, or of your cancer cells, to collect this information.
Your doctor might use personalised medicine:
-
to find out if you have a high risk of getting cancer and if you need screening or treatment to reduce this risk
-
to decide what is the best treatment for your cancer
-
to check if you have a high risk of side effects from your treatment
-
to work out the risk of your cancer coming back
-
as part of a clinical trial
Personalised medicine to reduce cancer risk
Some people have a 
in one of their genes which can increase their risk of certain types of cancer. It you have a very strong family history of one of these types of cancer, your doctor might offer you a genetic test. This can tell you if you have a faulty gene.
If you do have a faulty gene your doctor might offer you:
- regular screening
- surgery or medicine to reduce the risk of developing the cancer
Personalised medicine to choose the best cancer treatment
Cancer cells have changes in their genes (DNA) that make them different from normal cells. Genes are coded messages that tell cells how to behave. These gene changes mean that cancer cells behave differently from normal cells.
Your doctor might send some of your cancer cells to the laboratory for tests. These tests look for gene changes in the cancer cells. Your doctor can use the results of these tests to help them decide on the best treatment for you.
Doctors already use personalised treatments on a number of cancers. We have included some examples below.
Chronic myeloid leukaemia (CML)
CML is a type of cancer that affects the blood and bone marrow. Most people with CML have a change in a gene called BCR-ABL1. You may hear this being called the Philadelphia chromosome.
If your CML tests positive for the Philadelphia chromosome, you might have:
- imatinib
- dasatinib
- nilotinib
- ponatinib
Lung cancer
Epidermal growth factor receptor (EGFR) is a protein found on the surface of cells. EGFR helps the cells to grow and divide. Some lung cancers have a change (mutation) in the EGFR gene.
If your lung cancer has the EGFR change, you might have treatment with one of the following drugs:
- gefitinib
- afatinib
- erlotinib
- dacomitinib
- osimertinib
Some lung cancers also have a change in a gene called anaplastic lymphoma kinase (ALK). If this is the case, you might have treatment with:
- crizotinib
- ceritinib
- alectinib
Breast cancer
Some people with breast cancer have receptors for a hormone called oestrogen. They are called or ER positive cancer. Your doctor can check for these receptors when you are diagnosed.
For example, tamoxifen is a hormone therapy drug. It works by blocking the oestrogen receptors. Tamoxifen is only likely to work if you have ER positive breast cancer.
Bowel cancer
Some bowel cancers have changes in a gene called K-RAS. Drugs called cetuximab (Erbitux) and panitumumab (Vectibix) only work on cancers that have a normal version of this gene. This normal version is also called a RAS wild type gene.
Your doctor usually tests for this before you start treatment with these drugs.
Melanoma skin cancer
Some types of melanoma have changes in a gene called BRAF. Doctors usually test for this gene change. You might have treatment with targeted cancer drugs such as dabrafenib or encorafenib if you have BRAF positive melanoma.
CAR T-cell therapy
CAR T-cell therapy is a type of personalised immunotherapy. T cells are an important part of our immune system. They help to fight infection and diseases, including cancer. But cancer cells can sometimes hide away from the immune system.
With this treatment, a specialist nurse collects your T cells. In the laboratory, scientists make changes to the T cells and they become CAR T-cells. After a few weeks, you have a drip containing these cells into your bloodstream. The CAR T-cells are more able to recognise and attack the cancer cells.
This treatment is quite specialised. You can only have it at hospitals that are registered as CAR T-cell treatment centres. It's a treatment for children and adults with certain types of leukaemia and lymphoma. People with other types of cancer might have it as part of a clinical trial.
Personalised medicine to check your risk of treatment side effects
Fluorouracil (5FU) and capecitabine are two common chemotherapy drugs. They are used as a treatment for several different cancers. An called DPD helps our body to break these drugs down.
Without enough DPD enzyme, these drugs build up in the body and cause more severe side effects than usual. In some situations, these side effects can be life threatening.
Before starting treatment with capecitabine or fluorouracil, you have a blood test to check your levels of DPD. The results tell your doctor if you need treatment with a lower amount (dose) of the drug or if you should have a different treatment.
Personalised medicine to work out the risk of your cancer coming back
If you have breast cancer, your doctor might suggest you have specialist gene tests on your cancer cells. The results of these tests give your doctor information about whether chemotherapy can lower the risk of your cancer coming back.
There are different types of these tests for breast cancer. They include:
- EndoPredict (EPclin score)
- Oncotype DX Breast Recurrence Score
- Prosigna
Research into personalised medicine
Researchers in the UK and around the world continue to look into personalised medicine. They hope to:
- find out more information about the genetic makeup of each cancer
- develop new tests that can look for gene changes
- develop new treatments that target a particular gene change
Stratified medicine
Stratified medicine means looking at large groups of people to find out which treatments will work on which cancers. It’s one step towards personalised medicine.
Cancer Research UK launched a stratified medicine programme in 2010. In the first part of the programme, researchers collected samples from around 9,000 people with different types of cancer. They looked at the different genetic changes in the samples.
This study led to the next part of the programme, called SMP2. This tested for genetic changes in non-small cell lung cancer (NSCLC). Based on the gene changes found, some people were able to take part in the National Lung Matrix trial. Those taking part had treatment depending on specific changes to genes in their cancer cells.
The 100,000 genomes project
The 1000,000 genomes project is an NHS research project. It aims to look for the genetic causes of cancer and other rare diseases in a large number of people.
Everyone who took part gave a sample of blood, saliva or tissue. Researchers tested these samples to look at all the genes inside the cells. This information is being stored in a secure national library. Approved researchers can access this information to study diseases and look for new treatments.
Personalised cancer vaccines
In 2024 the NHS opened its Cancer Vaccine Launch Pad. This project aims to helps people with cancer access personalised vaccine trials.
A type of personalised vaccines is an mRNA vaccines. mRNA carries messages from our genes that tell cells what type of protein to make.
Researchers think they can give people with cancer a small piece of mRNA from their own cancer cells. People have this as an injection. It helps the cells of the immune system better recognise and destroy cancer cells.
Does personalised medicine always work?
Unfortunately, no one can guarantee that treatment will work even when you had tests to look for gene changes.
A treatment might not work because there are other changes in the cell we don’t know about, or don’t have a test for yet.
What next?
We will find out more about which treatments work with these and other cell changes as we continue with this area of research.
Cancer Research UK is working with the NHS and pharmaceutical and medical companies. We aim to develop more tests and treatments and make them available in the NHS.
