Abstract
s of digitalization of the Russian econ- omy is the creation of industry-specific digital platforms based on various combinations of economic methods for processing large amounts of infor- mation in all spheres of society, including in the field of healthcare. This circumstance determines the relevance of this study in relation to cancer. The Onco Genotest company has developed an innovative digital plat- form, the functionality of which allows to determine the molecular genetic profile of the tumor and, based on it, select the optimal individual treatment regimens for patients with the goal of obtaining better results compared to traditional therapy. The innovative activity of the company is aimed at introducing into practice a personalized approach to the selection of spe- cific methods of treatment of cancer patients. The results can be used in the diagnosis of cancer and the determination of methods for personalized therapy of cancer patients. Keywords: Russian economy, digitalization, oncological diseases, dig- ital platform, functional, molecular-genetic portrait of the tumor, personal- ized therapy. Introduction The target program “Digital Economy of the Russian Federation” as one of the main tasks of digitalization of the Russian economy provides for the creation of intersectoral digital platforms based on a combination of 1 This article was prepared with the financial support of the Russian Foundation for Basic Research, project №20-10-00140a "Methodological aspects of modeling the Russian econo- my in the context of digitalization: sectoral breakdown."
10Process Management and Scientific Developments various digital methods of information processing with specific methods to radically improve the functioning of all areas of society, including health [1]. In modern conditions, the digital platform economy is one of the promis- ing trends in the development of a digital society, which helps to expand the practice of using methodological tools and innovative mechanisms from related fields of knowledge based on expanding access to information technologies and Internet resources. A digital platform can be defined as “a system of algorithmic relationships of a sufficiently large number of market participants, operating on the basis of a single information environment and allowing to reduce transaction costs by using a set of digital technolo- gies and improving the principles of the division of labor [2]. Today in the world community it is customary to distinguish three main types of digital platforms. 1. Instrumental digital platform. It is based on a software or hardware- software complex (product) and solves individual applied problems. 2. Infrastructure digital platform. It is based on the unification of market participants in the information ecosystem to provide consumers in related sectors of the economy with turnkey solutions for automating their activi- ties through the use of IT services implemented in its infrastructure. 3. Applied digital platform. It is a business model with the ability to algo- rithmically exchange certain values between a significant number of indepen - dent market participants in a single information environment, which leads to a sharp decrease in transaction costs due to the use of digital technologies. In our country, two major information platforms are among the leading digitalization projects in the healthcare sector. 1. Unified State Information System in The Field Of Healthcare (USISH). It is a combination of information technology and technical tools that pro- vide information support for methodological and organizational support for the activities of participants in the health system. 2. Unified Medical Information Analytical System of Moscow (UMIASM). It has been operating since 2012. To date, the number of users of this sys- tem has exceeded 9 million people and more than 10 thousand
of information technology and technical tools that pro- vide information support for methodological and organizational support for the activities of participants in the health system. 2. Unified Medical Information Analytical System of Moscow (UMIASM). It has been operating since 2012. To date, the number of users of this sys- tem has exceeded 9 million people and more than 10 thousand employees of medical institutions. The functionality of this system is constantly ex- panding, but so far it has implemented a range of the most routine opera- tions: maintaining medical records, making an appointment with a doctor, getting directions for tests and examinations, filling out a sick leave, getting a prescription, etc. [3]. This article will reveal the experience of the practical use of applied digital platforms (of the third type) in Russia for the choice of treatment methods for cancer patients.
11Process Management and Scientific Developments Main part 1. Promising areas of cancer treatment In the modern world, oncology takes the 2nd place among diseases by the number of deaths for humans. However, only 5-10% of cases of cancer are associated with a genetic predisposition. Most of the cases are associated with diseases that a person acquires in the course of their life. The way out of this situation is seen in the development of genetic testing systems in order to determine oncological diseases and select the neces- sary therapy. In the United States, the Food and Drug Administration (FDA) has cur- rently approved about 50 molecular genetic tests for cancer detection. The FDA is responsible for protecting public health, ensuring the safety and efficacy of human and veterinary medicines, biological products, medical devices, food, cosmetics and products that emit radiation. The FDA also provides accurate, evidence-based medical information for the public [4]. Moreover, in 2018 alone, the FDA approved 15 new targeted drugs, and as of the end of the 3rd quarter of 2019, more than 900 targeted drugs were under development. Targeted or molecular-targeted therapy is one of the promising and rapidly developing areas of drug treatment (pharmaco- therapy) of cancer [5]. Carrying out such developments requires significant financial invest- ments. In 2017 alone, global investment in genomics amounted to 1.3 bil- lion US dollars. By 2024, the global genetic testing market is expected to be 23 billion US dollars[4]. In Russia, about 600 thousand cases of cancer are detected annually, and the annual increase in such diseases throughout the country is 3%. For the prevention of cancer and treatment of cancer patients in Russia until 2024, 969 billion rubles are allocated [3]. Hundreds of publications annually appear in Russian and foreign sci- entific literature with the results of clinical trials, reviews of modern drugs, evaluation of diagnostic methods and the effect of certain mutations on the metabolism, progression and other characteristics of various tumors. Only the pages of the Russian Internet portal RosOncoWeb published more than 80 clinical trials that are currently underway [6]. If we take the
Russian and foreign sci- entific literature with the results of clinical trials, reviews of modern drugs, evaluation of diagnostic methods and the effect of certain mutations on the metabolism, progression and other characteristics of various tumors. Only the pages of the Russian Internet portal RosOncoWeb published more than 80 clinical trials that are currently underway [6]. If we take the world experience, then this figure will be an order of magnitude higher. The above circumstances contributed to the emergence of a steady tendency to increase the pace of development of personalized methods and ap- proaches to the treatment of cancer patients. However, in our country there are currently a number of problems in resolving this issue. The main one is that in Russia today there is no labo-
12Process Management and Scientific Developments ratory that would meet all the requirements of modern clinical oncology in terms of molecular genetic oncology. There are also no laboratories per- forming a full range of molecular genetic testing. NGS testing (Next Gen sequencing - next generation sequencing) takes an average of 2 months. 2. Development of research methods and programs in the field of on- cology Below are the main areas of research in the field of cancer treatment, starting from 1977 to the present, namely: - 1977 – the advent of sequencing — the dideoxynucleotide method, or the “chain termination” method, developed by F. Senger in 1977 [7]; Today, this method is widely used to determine the nucleotide sequence of DNA. - 2005 – the advent of the first commercial NGS (Next-generation se- quencing) sequencing for high-performance DNA sequencing developed by the biotechnological company 454 LIFE SCIENCES; - 2006 – launch of the TCGA (The Cancer Genome Atlas) program for cataloging genetic mutations that cause cancer, using genome sequencing and bioinformatics at the cellular level; - 2014 – launch of the MSK-IMPACT target test for mutations in both the rare and common oncological diseases within the TCGA program at the MEMORIAL SLOAN KETTERING CANCER CENTER, a cancer research center in New York; - 2017 – the FDA approved the T790M mutation analysis in the EGFR gene to determine indications for EGFR inhibitors in some forms of lung cancer (NSCLC); - 2018 – the FDA has approved the use of immune therapy for MSI-H tumors, of any location; - currently (2019-2020) – the use of the drug against cancer LAROTREK- TINIB for the treatment of tumors with rearrangements of the NTRK gene - Neurotrophic receptor tyrosine kinase, regardless of the localization of formation is approved; - currently (2019-2020) –the use of TMB - MARKER of the mutational load of the tumor to determine the indications for immune therapy in the first line of treatment of some forms of lung cancer (NSCLC) is approved [4]. 3. Functionality of the Onco Genotest digital platform Onco Genotest company has successful experience in practical work with
Description
The article discusses the genetic factors contributing to cancer resistance.