Archives of Digestive Disorders

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Opinion Article - Archives of Digestive Disorders (2023) Volume 5, Issue 3

Precision medicine approaches in gastrointestinal oncology: Current status and future directions.

Rubinstein Argelia *

Department of Nutritional Medicine/Prevention, University of Hohenheim, Fruwirthstrasse 12, Stuttgart, 70593, Germany.

*Corresponding Author:
Rubinstein Argelia
Department of Nutritional Medicine/Prevention, University of Hohenheim, Fruwirthstrasse 12, Stuttgart, 70593, Germany.
E-mail: argeliarubin112@gmail.com.edu

Received: 20-April-2023, Manuscript No. AAADD-23-100543; Editor assigned: 21-April-2023, PreQC No. AAADD-23-100543(PQ); Reviewed:05-May-2023, QC No. AAADD-23-100543; Revised: 08-May-2023, Manuscript No. AAADD-23-100543(R); Published: 19-May-2023, DOI:10.35841/aaadd-5.3.147

Citation: Argelia R. Advances in endoscopic techniques for the diagnosis and management of digestive disorders. Arch Dig Disord. 2023;5(3):147

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Introduction

Gastrointestinal (GI) cancers, including colorectal, gastric, and pancreatic cancers, account for a significant burden of cancer-related morbidity and mortality worldwide. Traditional treatment approaches have relied on a one-size-fits-all paradigm, often resulting in suboptimal outcomes due to the inherent heterogeneity of these malignancies. Precision medicine, on the other hand, offers a more targeted and personalized approach by considering individual patient characteristics and the molecular features of the tumor. In recent years, precision medicine has emerged as a promising strategy in GI oncology, enabling clinicians to select therapies that are more likely to be effective and minimize unnecessary toxicity. In this review, we aim to provide an overview of the current status of precision medicine approaches in GI oncology, highlighting the advancements made in genomics, proteomics, and other molecular profiling techniques. We will also explore the potential future directions and challenges that need to be addressed for the widespread implementation of precision medicine in clinical practice [1].

Genomics has played a pivotal role in advancing precision medicine in GI oncology. Comprehensive genomic profiling has allowed for the identification of key molecular alterations that drive tumor growth and progression. In colorectal cancer, for instance, the discovery of oncogenic mutations in genes such as KRAS, NRAS, and BRAF has not only provided prognostic information but has also guided treatment decisions. Targeted therapies, such as anti-EGFR antibodies, have been successfully implemented in patients with specific mutations, resulting in improved outcomes. Similarly, in gastric and pancreatic cancers, genomic profiling has revealed actionable alterations, including HER2 amplification and BRCA mutations, which can be targeted with specific therapies. Despite these advancements, challenges such as tumor heterogeneity and the emergence of resistance mechanisms necessitate further research to identify additional molecular targets and develop effective combination therapies [2].

Proteomics is another valuable tool in precision medicine, offering insights into the protein expression patterns and signaling pathways that drive GI cancers. Proteomic analyses have identified potential therapeutic targets, such as the human epidermal growth factor receptor 2 (HER2) in gastric cancer. HER2-targeted therapies, originally successful in breast cancer, have shown promise in a subset of gastric cancer patients with HER2 overexpression. Additionally, proteomic profiling has contributed to the understanding of the tumor microenvironment and immune response, guiding the development of immunotherapeutic strategies. Immune checkpoint inhibitors, such as pembrolizumab and nivolumab, have shown efficacy in a subset of patients with microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) tumors, emphasizing the importance of molecular profiling in immunotherapy selection [3].

Liquid biopsies have emerged as a non-invasive and dynamic tool for molecular profiling in GI cancers. By analyzing circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and other biomarkers in blood samples, liquid biopsies provide real-time information on tumor heterogeneity and treatment response. Liquid biopsies have shown promise in detecting minimal residual disease, monitoring treatment response, and detecting acquired resistance mechanisms. In GI oncology, liquid biopsies have been particularly useful in the management of metastatic colorectal cancer, where they can identify RAS mutations and monitor the emergence of resistance to targeted therapies. Despite the potential of liquid biopsies, standardization, and validation of these assays are crucial for their widespread adoption in routine clinical practice [4].

The advent of artificial intelligence (AI) has significantly impacted precision medicine in GI oncology. AI algorithms can analyze large datasets, including genomics, proteomics, radiology, and electronic health records, to generate predictive models and treatment recommendations. AI-based approaches have shown promise in predicting treatment response, stratifying patient prognosis, and identifying novel biomarkers. For example, machine learning algorithms have been employed to predict the likelihood of response to specific chemotherapeutic agents in colorectal cancer patients. Furthermore, AI has been utilized in image analysis to improve the accuracy of tumor detection, classification, and staging. Integration of AI into clinical decision-making processes holds great potential for optimizing treatment outcomes and facilitating the implementation of precision medicine [5].

Conclusion

Precision medicine approaches have significantly advanced the field of GI oncology, allowing for more personalized and effective treatments. Genomic and proteomic profiling have revealed actionable targets and guided therapy selection, leading to improved patient outcomes in subsets of patients. Liquid biopsies and AI-based approaches offer promise in real-time monitoring and predictive modeling, respectively. However, challenges such as the identification of reliable biomarkers, tumor heterogeneity, and resistance mechanisms must be addressed for precision medicine to become routine in clinical practice. Continued research and collaboration are necessary to further refine precision medicine strategies, ultimately benefiting patients with GI cancers and paving the way for a future where treatment decisions are tailored to individual molecular profiles.

References

  1. Chakravarthy A, Furness A, Joshi K, et al. Pan-cancer deconvolution of tumour composition using DNA methylation. Nature communications. 2018;9(1):3220.

    2. Indexed at, Google Scholar, Cross Ref

  2. Dienstmann R, Vermeulen L, Guinney J, et al. Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer. Nat Rev Cancer. 2017;7(2):79-92.

    3. Indexed at, Google Scholar, Cross Ref

  3. Marquard AM, Birkbak NJ, Thomas CE, et al. TumorTracer: a method to identify the tissue of origin from the somatic mutations of a tumor specimen. BMC Med Genom. 2015 Dec;8:1-3.

    4. Indexed at, Google Scholar, Cross Ref

  4. Sharma P, Hu-Lieskovan S, Wargo JA, et al. Primary, adaptive, and acquired resistance to cancer immunotherapy. Cell. 2017 Feb 9;168(4):707-23.

    5. Indexed at, Google Scholar, Cross Ref

  5. Yarchoan M, Hopkins A, Jaffee EM. Tumor mutational burden and response rate to PD-1 inhibition. N Engl J Med. 2017;377(25):2500-1.

    6. Indexed at, Google Scholar, Cross Ref

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