Importance of combination therapy with multiple anti-tumor agents in cancer genomic medicine in Japan

The National Cancer Institute (NCI) announced that new initiative will evaluate the effectiveness of drug combinations to treat cancers with particular genetic changes.

From December 2019 to April 2023, in cancer genomic medicine at a Japanese national university, new therapies for total of 2991 patients with malignances have been considered by cancer genome testing (Ncc oncopanel test: 679 cases, F1CDx test: 2312 cases). To date, 1187 cases (39.7%) of patients have been detected with pathogenic variants by cancer genome testing. Furthermore, 365 cases (12.2%) of patients were treated with anti-tumor drugs selected by cancer genome testing.

In cancer genomic medicine in Japan, single-agent administration of already approved anti-tumor agents is prioritized for cases in which pathogenic variants have been detected in multiple molecules in a single patient. Next, an antitumor agent that has been shown to be effective in clinical trials and case reports is administered as a single agent. Until now, in cancer genomic medicine in Japan, combination therapy with multiple antitumor agents has not been performed for patients with pathogenic variants in multiple molecules.

As future cancer genomic medicine, for example, in advanced or recurrent uterine leiomyosarcoma, for cases in which a pathogenic variant in BRCA2 and an active pathogenic variant in AKT are detected by cancer genome testing, combination therapy with a PARP inhibitor (Olaparib or Niraparib) and a tyrosine kinase inhibitor should be considered. Currently, in clinical trials, pharmaceutical companies are examining the efficacy of combination therapy with multiple approved anti-tumor agents against various advanced and recurrent malignancies. It is clear that the results of these clinical trials are important for the development of cancer genomic medicine.

We do not have potential conflicts of interest.

Doctor specializing in cancer care.
Doctor specializing in emerging infectious diseases.

Published in JAMA on June 16, 2923, by kyoto@takumah