More effective, individualized cancer treatment

APO-DECIDE program offers new clinical decision-making tool to categorize patients based on their biological and genetic characteristics


HIGH COST and dreadful side effects of chemotherapy are common complaints among cancer patients and their families. Since decision making on treatment depends mostly on factors such as size of tumor and age of patient, which is a “one size fits all” approach, the results can be disappointing in some cases.

Tumors can be unresponsive to chemotherapy. Tumors are composed of various types of cells and most of them develop resistance to drugs. For example, for a certain kind of colorectal cancer, up to 50-60 percent of the patients can become unresponsive to the standard treatment.

New way to treat cancer

Systems biology, a computational approach that uses mathematics to explore how proteins interact with each other, provides hope. The APO-DECIDE (Apoptosis Modeling for Treatment Decisions in Colorectal Cancer) project led by Prof. Jochen Prehn at the Royal College of Surgeons in Ireland, has developed a new clinical decision-making tool to help doctors categorize patients on the basis of their individual biological and genetic characteristics.

In an interview with Research EU magazine, Prof. Prehn explains, “There are numerous genes and pathways in human cancers, and no single patient is like another. We now need to employ computational approaches to understand the complexity of genes and protein altered in individual cancer patients.”

According to the Research EU magazine article, “At the Threshold of Personalized Cancer Treatment,” the crux of cancer treatment lies with apoptosis or programmed cell death. Current chemotherapy treatments increase apoptosis in the tumor or nudge the cells along the path to self destruction.

Using the APO-DECIDE system, an oncologist will be able to work out the dose of the apoptosis promoter required on an individual basis. This means the patient receives a dose best suited to treat his tumor right from the start.

The new system analyzes the cancer at a molecular level. The information will then be used to identify weak spots in the tumor that can be targeted with new drugs (apoptosis sensitizers) that reprogram tumor cells to respond to treatment.

Less cost and damage to patients

This new strategy avoids a situation where in a patient who is not responsive to the drugs has to endure the harsh chemotherapy treatment needlessly. Analyzing the chemical pathways (strings of biochemical reactions) in a tumor before therapy, and knowing that the tumor will be responsive— reduce uncertainties and unnecessary expenses, so that scarce resources can be used to maximum benefits.

This system works not only for colorectal cancer but extends to other cancers as well. According to Prof. Prehn, researchers now widely accept that the chemical roots of a tumor’s resistance to treatment are the same for most cancer cell types.

As common pathways are responsible for a tumor’s resistance to chemotherapy drugs, the APO-DECIDE system is useful in the battle against other types of cancer. Most important, this system can also de-sensitize normal cells vulnerable to damage during chemotherapy, such as bone marrow stem cells.

The APO-DECIDE system research project funded by the European Union ended last November and could be used in clinics by 2017.

Know more about the details of this medical breakthrough at the project website,

Vital Signs Issue 78 Vol. 4, August 1-31 2015