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Romania-Serbia project: diagnosis and personalized treatment in cancer

Oncology patients have access to diagnosis and personalized treatment of the disease, with the help of modern equipment from the Center for Gene and Cell Therapies in Cancer Treatment OncoGen within the "Pius Brînzeu" County Emergency Clinical Hospital Timisoara. The equipment was purchased through the strategic project "Romania-Serbia joint initiative against cancer in the cross-border region: improving the diagnosis and treatment of malignant tumors - ROSECAN".

Modern systems were used in 2019 to analyse more than 80 samples, detecting more than 100 gene mutations in patients with various tumours. "Thirty samples were analysed using the Illumina MySeq system, with which we obtained data related to the cancer patient's immune response, i.e., the number and type of cytotoxic T lymphocyte clones, which are cells with the ability to destroy tumour cells. 20 samples were analysed using the Ion Torrent Studio S5 system and the automated sample preparation station, identifying over 89 gene mutations in more than 30 genes investigated from patients with solid tumours; the sample preparation station proved to be extremely useful in shortening the processing time and preparing the samples for sequencing, which made the time from receipt of samples to release of results approximately seven days," said Prof. PhD. Carmen Panaitescu Bunu, deputy coordinator of the centre.

At the same time, circulating free DNA (cfDNA) was analyzed from peripheral blood samples received from eight cancer patients, identifying mutations in 25 oncogenes. Currently, at the level of the OncoGen Center, there is the possibility of performing approximately one hundred more gene sequencing analyses. "This successfully completed stage brings us closer to achieving our goal, that of providing oncology patients with a personalized diagnosis and therapeutic guidance for the treatment of malignant tumors. Through this methodology, new molecular targets existing at the level of tumors can be identified, thus being able to develop therapeutic strategies such as personalized vaccines or cellular immunotherapy. Gene sequencing does not involve any risk for patients, this method is carried out from the DNA extracted from the tissue embedded in paraffin, after establishing the histopathological diagnosis of the tumor", said the specialist.

Through this sequencing, Romania is adapting to existing global standards for precision diagnosis and personalized treatment of cancer. "We can no longer treat all tumors with the same standardized methods, but must individualize. In this respect, the machines we have acquired in the Romania-Serbia project help us to do the same thing as abroad - that is, to take the patient's tumor samples, sequence them, get the mutation from the DNA and, based on those mutations, search the databases or use dedicated software that can tell us which therapies would be appropriate for the patient with those mutations. Moreover, going on the same alignment with European standards, the machines purchased in the project have also helped us to move towards the personalization side, i.e. vaccine generation. We are currently trying to develop software to predict new therapeutic targets for the cells of the patient's immune system against cancer," explained Dr. Forina Bojin, researcher at OncoGen.

Currently, OncoGen is the only center that belongs to the public health system where such analyzes can be done free of charge for Romanian patients. "Furthermore, we want to be able to introduce this set of analyses, which in other countries is settled, on the list of those insured by contract with the National Health Insurance House, so that as many patients as possible can benefit from them. The cost of these analyses is not excessively high, but financial support would be necessary for sick people, who cannot afford costs of 500-1,000 euro, depending on the type of analysis. The patients analyzed so far were recruited based on certain inclusion criteria established according to the protocol: they are patients with solid tumors and cancers located in various areas of the body, not leukemias. The respective samples, according to the protocol, are processed, analyzed, the patient receives the result and is referred to the oncologist. Oncologists are also the ones who refer patients to us for a precision diagnosis after they have exhausted every therapeutic resource", said the researcher.

The researches were possible thanks to the strategic project "Joint initiative Romania-Serbia against cancer in the cross-border region: improving the diagnosis and treatment of malignant tumors - ROSECAN", financed by the program Interreg-IPA CBC Romania - Serbia. The project runs from 2017 to 2021, in partnership with the Ministry of Health of the Republic of Serbia, the Pozarevac General Hospital and the Resita County Emergency Hospital, with a total budget of over 12 million euros, of which approximately 3 million euros go to the OncoGen Center .

"It is not only a partnership between two medical institutions, it is one between two countries. Our advantage, that we do not have an institute of the caliber of OncoGen in Serbia, is that we can learn from the experience of our Romanian colleagues, regarding the personalized treatment of the Serbian cancer patient. Over the next two years, medical seminars and training sessions will be organized with oncologists from both countries so that they can use the software developed by OncoGen to improve the care of their own patients. In addition, within the project, 100 cancer patients in Serbia will be able to benefit from sequencing – that is, precision diagnosis and personalized treatment. After this training period, the software will be able to be used in all our hospitals", said Danko Nikolić, coordinator of the ROSECAN project, director of the Požarevac General Hospital in Serbia.