onkommon.com
Systemic therapy
Targeted therapy
Medicines matched to a specific alteration found in your tumour.
What it is
Targeted therapy acts on a particular molecular alteration, a driver mutation, a fusion, an amplification. It is only useful if that alteration is actually present, which is why the test comes before the prescription.
Many of these are tablets taken at home. That makes them feel less serious than an infusion. They are not: adherence, interactions and monitoring all matter, and stopping without telling anyone can undo months of progress.
When it is used
- Where molecular testing identifies an alteration with a matched medicine
- Where resistance has developed and re-testing shows a new alteration
- In combination with other treatment, in defined settings
How the decision is made
- Which test tier is needed to answer the question, not the largest panel available, the right one.
- Whether the alteration found is genuinely actionable, and at what evidence tier. On-label, off-label and evidence-tiered options are distinguished in writing.
- Whether a clinical trial is a better route to the medicine than paying for it.
- Re-profiling at progression. A profile from two years ago describes a tumour that no longer exists.
Usually oral, taken at home. Some are infused at a partner day-care unit.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- Testing strategy and tier selection, ordered and signed by an oncologist
- Interpretation read against your clinical picture at the board
- Evidence tier stated against every option, including the ones we reject
- Trial matching from a maintained registry
- Adherence follow-up and interaction review
- Re-profiling protocol at progression
Performed and billed elsewhere
- The molecular assay, performed and billed by OnKommon
- The medicine, dispensed by a pharmacy
- Imaging for response assessment
- Tell every doctor you see that you are on a targeted medicine. Interactions with common drugs, including antacids, antibiotics and some herbal preparations, can make them stop working or become toxic.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- What alteration was found, and what evidence tier supports treating it?
- What does the whole course cost, and is there an assistance programme?
- Is there a trial I would be eligible for?
- What do we do when it stops working, do we re-test?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Breast cancer
Including hormone-receptor positive, HER2-positive and triple-negative disease
Colorectal cancer
Colon and rectal cancer, bowel cancer
Skin cancer & melanoma
Melanoma, basal cell and squamous cell carcinoma
Leukaemia
Acute and chronic leukaemias. ALL, AML, CLL, CML
Thyroid cancer
Papillary, follicular, medullary and anaplastic thyroid cancer
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.