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Dr. Antoaneta Tomova is Head of the Department of Medical Oncology and Oncological Diseases in Gastroenterology at the Complex Oncology Center – Plovdiv, where he works from 1988 r. until. She graduated from the Medical University – Sofia. He has specialties in internal medicine and oncology, she specializes in palliative care and symptomatic control at Oxford, England, medical oncology c “Charing Cross” – London, medical oncology at the Medical University – Vienna, Austria, as well as in Greece and Manchester – “Kristi hospital”, England. She participated in over 30 trainings at the European School of Oncology for the treatment of solid tumors and at the congresses of the European and American Association of Oncology. From 2002 to 2010 r. is a member of the Central Commission for Distribution of Expensive Medicines and an expert of the Ministry of Health. Member of the Management Board of the Bulgarian Oncology Society and of the Medical Commission attached to it. Member of BUON, ESMO, DISGUST. Author for publications in Lancet Oncology, Journal of Clinical Oncology; Annals of Oncology; Breast Cancer Research and Treatment; Journal of Thoracic Oncology; Lung Cancer – Elsevier; Oncologists at BOD; European journal of cancer и др. Winner of the award “Doctor of the Year” of the National Patient Organization for 2009 r. Winner of the award “Doctors, which Bulgarians believe” from 2011 r. so far annually. Co-author of two publications in JCO – Journal of Clinical Oncology.
Dr. Tomova, personalized medicine is far from a new concept in oncology. How it changes the approach to patients and their treatment?
– At the present stage, personalized medicine most clearly demonstrates its advantages in the field of oncology, where, thanks to the precise diagnosis and targeted therapy, oncological diseases have practically become chronic.
Advances in personalized treatment are based primarily on understanding, that cancer is a heterogeneous genomic disease. This gave impetus to the development of new technologies in diagnostics and precise therapeutic approaches, which have a positive impact on the outcomes of cancer patients. There is a remarkable breakthrough in the diagnosis and treatment of agnostic malignancies. There are already approved therapies based on the presence of biomarkers, and not on tumor localization.
Genomic profiling is the basis of precision medicine. It involves understanding the tumor genome, use of the immune system in treatment, the administration of a specific treatment according to the individual's unique tumor genome or combination regimens, to influence the complex molecular signature of the tumor.
Determining which alterations cause a patient's cancer is the key to offering more precise treatment options..
Driver alterations are those alterations, involved in the growth and development of the patient's cancer. Next-generation genomic profiling and associated bioinformatics can be used to identify potential driver alterations. Identified driver alterations can potentially be treated more precisely, in the same way the treatment can be adapted, if resistant mutations are detected during therapy, which can improve patient outcomes.
What is your experience with comprehensive genomic profiling?
– I have extensive experience with Foundation Medicine's comprehensive genomic profiling services for patients with non-small cell lung cancer, breast cancer, where new biomarkers with potential for influence and targets for treatment have been discovered in recent years, as in sarcomas, where there are great unmet medical needs and the need for molecularly targeted treatment options.
I would like to emphasize another possibility, which is accessible to patients – comprehensive genomic profiling with liquid biopsy. In a large percentage of cases, the initial tissue biopsy is insufficient for accurate diagnosis and in many cases genomic profiling of the tumor with progression is not possible due to technical limitations for obtaining new samples of tumor tissue. Therefore, effective alternatives for molecular diagnostics are needed, which includes a liquid biopsy. In addition, tumor biopsy provides only a snapshot of the tumor and allows doctors to learn about the mutational status of the tumor over a period of time.. To be able to monitor the patient's condition, several such interventions should be performed as the disease progresses. Additional, if the sample was taken long ago and at another stage of the disease, it will not significantly help our judgment in prescribing the appropriate treatment to the patient.
Comprehensive genomic profiling with liquid biopsy involves measurement of circulating tumor DNA in blood samples, obtained from cancer patients. This diagnostic approach is fast and non-invasive.
Circulating tumor DNA can be used to track changes in cancer over time and is very useful in monitoring patients.. Comprehensive genomic profiling with liquid biopsy analyzes circulating tumor DNA, which may originate from primary and metastatic tumor localizations, thus capturing the complete heterogeneity of the disease in the body during its development. For example, in non-small cell lung cancer, targeted therapies allow for an individualized approach to treatment.. Initial therapeutic decisions and the success of targeted therapy depend on the genetic identification of the specific tumor profile.. The inclusion of a liquid biopsy in the management of non-small cell lung cancer provides strong evidence for an early response to treatment or becomes the basis for determining disease progression and the need for treatment changes..
And last but not least, this type of examination does not cause discomfort to the patient and does not affect his general condition, as it only requires blood sampling for testing.
Is this method of diagnosis used around the world, do you communicate with other colleagues to share experiences?
– Sharing experience with colleagues from Bulgaria and abroad is one of the biggest advantages nowadays and I am happy, that I manage to do it.
In this regard, one of the services of the comprehensive genomic profiling of Foundation Medicine is very useful for me and my patients.. It is related to the interpretation of the report and the result of genomic profiling, especially in complex cases and complex genomic changes. There is an opportunity to get advice and advice from experts in genomic profiling. This service allows for direct communication through a web-based platform between me as a doctor and internationally recognized experts in the field of genomic profiling..
A new solution is the possibility to discuss the result of genomic profiling in molecular tumor boards.. The molecular tumor board is an integrated comprehensive overview of the patient's characteristics, including clinical history, imaging diagnostics, pathology, laboratory results and molecular profiling, in the presence of specialists from different medical fields in order to develop an individual treatment plan for each patient. To integrate the ever-increasing amount of information into the clinical solution, we need to look at the whole picture, to make the best clinical decision for the individual patient – characteristics per patient, data from imaging studies, molecular information (genomic profiling data), data from pathological findings, the treatment options available and the corresponding levels of evidence for the use of molecularly targeted therapies.
I hope in the near future to have the opportunity to participate in molecular tumor boards with leading international experts with experience in genomic profiling, as this will help us, doctors, to make informed treatment decisions, and to patients – have access to innovative treatments and solutions for clinical trials.
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