By Sunitha Anandan |
January 17, 2019
Medical treatments generally have been based on the disease and not the patient, where patients with same disease are treated with the same treatment. This ‘one-size-fits-all’ approach to therapy can be successful for some patients, but some may have adverse effects despite showing a positive response, and some may not respond to treatment at all.
It was discovered that only 1 in 50 patients may benefit from taking statins used routinely to lower cholesterol levels. Though tamoxifen is widely used in the treatment for breast cancer, it is known that around 10% of patients have a gene resulting in resistance to the drug. An article in Nature noted that an estimated 90% of the conventional and top-selling blockbuster medicines only work for 30% to 50% of patients.
“It’s a very simple principle. You pick the right drugs for each patient based on the tumor profile, not based on a part of the body or based on what type of cancer 100 other people have. It’s all about that patient sitting in front of me.” – Razelle Kurzrock, Oncologist and Director, Moores Center for Personalized Cancer Therapy
To confront this scenario, healthcare is progressing from the ‘one-size-fits-all’ strategy to personalized medicine or precision medicine. Precision medicine aims to offer tailored care precisely to an individual, based on each patient’s genomic makeup, ethnicity, environment, lifestyle and more. Due to the concern that the word “personalized medicine” could be misinterpreted to imply that completely individualized treatments are being developed uniquely for each patient, the National Research Council (NRC) prefers the term “precision medicine” over “personalized medicine”.
The US Food and Drug Administration (FDA) is spearheading the precision medicine space – more than one of every four drugs approved over the past four years is a personalized medicine. In 2017, precision medicines toped (over 30%) the US FDA’s approvals of new drugs. Now, many top pharma/biopharma companies are directing their investment in precision medicine. Some firms are co-developing prescription medicines (Rx) and diagnostics (Dx) for future targeted therapies that will optimize the cost, time and success rate of clinical trials.
Harnessing the power of genomics, patient data, analytics and more!
Precision medicine provides a holistic view of an individual patient by probing a myriad of factors and creating precision tools unimaginable just a decade ago. It leverages big data, advanced machine learning technologies, genomics (DNA coding), exposomes, and patient clinical histories to provide care with best outcomes.
With genome sequencing, more and more diseases are being discovered enabling development of treatments tailored to individual data set. Currently, some health systems are offering genome sequencing as a routine part of preventive care, along with mammograms and colonoscopies. Understanding this genetic difference will aid physicians to avoid guesswork and helps with selecting a precise therapy sooner, thereby improving patient’s outcomes and limiting toxicities. Evidence suggests that genes are also impacted by our lifestyle, behavior, and environment which can cause genes to be switched on and off or even altered. Researchers now propose that a genomic profile will be part of everyone’s medical record in future.
“The mother’s voice to her offspring is one of the most primal precision medicines of all, because it primarily calls you and nobody else,” – Manuela Filippa, Researcher, Universities of Valle d’Aosta and Geneva. Experts propose that newborn’s brain stimulates and develops to interpret sounds and understand language in response to a mother’s voice!!
Moving forward, science will uncover extensive data about diseases that we may develop over the course of our lifetime. With the increasing use of smart phones, and mobile apps and wearable devices, patients are increasingly transmitting data (everything from sleep patterns to blood pressure levels) from home. Data-driven precision medicine will need analytical tools (e.g., machine learning) to access this vast amount of complex data and turn it into insights about care.
Blockchain technology is gaining momentum in managing and analyzing large data sets where patients could be paid for their clinical data, internet-of-things data, or genomic data. Blockchain can also assist in co-ordinating the care by tracking all the places an individual receives care and where his/her records are. This will lead to a library of health and genomic data, empowering doctors and researchers for precision medicine.
With the growing value of precision medicine, major healthcare organizations are expanding their businesses in this field. Centene, a health insurer dealing with Medicare and Medicaid, acquired Interpreta which is a clinical and genomics data analytics company. As a result Centene gained momentum to deliver precise care at the right time and at the right cost for the under-insured and uninsured. Interpreta evaluates a patient’s electronic health record (HER) against the genomic information in its database and develops a treatment recommendation. Many cloud-based digital health and wellness aid platforms such as Omada (digital behavioral therapies for diabetes patients) and Zipongo (personalized nutrition solutions) offer alternative therapies for individuals in the prevention and management of acute chronic health conditions.
With the timely merge of genomic data, patient-reported outcomes, big data and machine learning technologies, precision medicine builds a comprehensive health data loop that helps clinicians and researchers better treat and prevent disease. Healthcare systems need to potentially harness and adapt these capabilities while staying aware of emerging tools that can individualize care and further the mission of precision medicine.