It’s time to make medicine personal

Inside our blood, tissue or other bodily fluids is a wealth of information, unique to our own bodies. Biomarkers are indicators in our genetic profile, that can be used to predict, diagnose or prognose medical processes in our body. Because of our individual make-up, the same medicine can have very different effects on a patient. But through the strategic observation and application of biomarker knowledge, we can develop treatments personalized to a patient – keeping side effects to a minimum and optimizing effectiveness.

‘Whether it is cancer, autoimmune disease or an infection, as a doctor you want to deal with a disease in the most targeted way and to cause as little collateral damage as possible’, argued Go van Dam, founder of TRACER and until recently oncology surgeon at the UMCG. ‘That is working better by the day. With all the biomarkers that we use during diagnosis, such as the patient's genetic profile and the characteristics of a tumor, we are better at assessing which treatment will work. In recent years we’ve also had the use of immunotherapy.’

Immunotherapy doesn't attack the tumor directly, but the immune system is helped to destroy the tumor. Usually the immune system is perfectly capable of doing that. People constantly have cell damage. The immune system identifies the damaged cells and eliminates them before they can grow into a tumor. Some cancer cells cheat the immune system, and go under the radar as it were. ‘At that point you have two choices. Either you give antibodies that make the cancer cells visible again, so that the immune system can attack them. Or, and this is most effective, collect immune cells from the blood, cultivate them and give them a boost with so-called CAR T cells. Once back in the body, these killer cells switch off the cancer in a targeted fashion.’

Immunotherapy is on the rise and is already used for certain types of cancer, including melanoma and lung cancer. The big advantage is that is really works, but the disadvantage is that is doesn't work for everyone. The products are also expensive and the side effects can be significant. Instead of giving the product to all patients and using scans to check for whom it worked afterwards, which is standard practice, doctors would like to know who would benefit from the medication in advance. This can be achieved by testing the product with so-called ‘companion diagnostics biomarkers’.

That is exactly what TRACER’s technology does. ‘We administer the product, a therapeutic protein, in extremely small doses. In this microdose, the medication doesn't work and has no side effects. As we have given it a fluorescent label, we can see whether the boosted immune cells go to the tumor or not and whether it works or not. We can also see whether the cells end up in many other different places. In that case, you can expect side effects.’

A doctor in a clinic can use this information to assess whether their patient benefits from a specific registered product. It can also help pharmacists to accelerate the development of new medication. ‘That is actually the mainstay of our work’, explained Go Van Dam. ‘Usually it is fairly late on in the process when a pharmacist discovers whether a product is effective and whether its effect outweighs the side effects. At that point large amounts of money have gone into large-scale and long-term trials and hundreds of patients in those studies received medication that didn't work. In three to six months we can say a lot about the effect by giving patients a microdose and showing where the product ends up. This produces enormous cost savings and ensures that medication that does work well enters the market sooner. Not just for cancer, but for infections and for autoimmune diseases, such as Crohn's disease.’