Since President Barack Obama’s State of the Union Address in January 2015, where he spoke about the Precision Medicine Initiative, and his final State of the Union Address in January 2016, where he announced an effort to hasten a cure for cancer, the nation has been talking about a revolution in patient care.
Of course, the country is used to hearing the president talk about health care, especially the Affordable Care Act. But when the White House starts launching multi-million-dollar initiatives to accelerate cancer research, you can be sure it’s not just a passing fad.
What is precision medicine?
Precision medicine is about tailoring treatments to the patient’s genome and body function. The promise is that this detailed personal health data can determine what’s most effective for each individual, which can lead to better outcomes.
Most of precision medicine’s application currently focuses on cancer. Launched in 2013, Penn Medicine’s Center for Personalized Diagnostics (CPD) helps oncologists determine the best treatment for their cancer patients, based on looking at the cancer’s genome.
Here's how it works at Penn Medicine in five steps:
- A patient is diagnosed with cancer.
- If the cancer involves a solid tumor—like breast, lung, or colon cancer—the tumor is surgically removed during a biopsy and a chunk of the tissue is sent to the CPD. If the cancer involves blood or bone marrow—like leukemia—a sample of the blood or bone marrow is sent.
- A panel of genes are sequenced that are known to be involved in cancer. This test examines DNA within the tumor, blood, or bone marrow sample. The goal is to find DNA mutations that are driving the cancer.
- A report on the mutations found is sent to the patient’s oncologist.
- The oncologist determines if there are therapies or treatments available that work better than others—or not at all—on the patient’s particular type of cancer.
"We're using precision medicine to give patients the right drugs, guided by the DNA sequence information from their cancer, so we're not exposing them to potentially toxic effects," explains David Roth, MD, PhD, director of the CPD. "This individualized therapy is better than treatment based on the average patient."
Penn Medicine experts from the CPD share four predictions on how precision medicine will change how cancer is treated in future generations.
Cancer will be diagnosed earlier
Jennifer Morrissette, PhD, Clinical Director of the CPD:
There are different stages of tumors. The earlier you catch the tumor, the more likely you are to survive it. My theory is that this century will be the century of diagnostics. We will be diagnosing people's cancers earlier and earlier.
That way, we are not dealing with advanced metastatic tumors that have acquired so many different changes that they’re hard to treat. We’ll be capturing tumors very early, in stage one, have a definitive surgery, follow the patient for a certain number of years to make sure that the cancer hasn’t spread, and they’ll be cured.
Some people put off seeing a physician because they don't want chemo, but the longer they put it off, the more likely they are going to have metastatic disease.
Cancer treatment will be based on each patient's health profile
Dr. David Roth:
Doctors had been treating based upon results from a large study and were treating for the average patient.
The revolution in precision medicine is that now we have better tools to understand what’s going on with you as an individual. We can know much more precisely instead of saying, "Okay, you have this particular cancer, and you have a 30 percent chance. So, go ahead and get this toxic therapy."
Now, we can be much more specific about that. If we were able to tell you that you have a five percent chance of responding to a chemotherapy based on the makeup of your tumor, would you still do it?
Gene paneling will be used for diagnosis, not just treatment
David Lieberman, MS, CGC – Certified Genetic Counselor:
We tend to see certain genes mutated in certain cancers. For example, there is a certain set of genes [that are] typically mutated in lung cancer or another set in lymphoma.
It is not always clear using historical methods what type of cancer a patient has. This makes treatment decisions challenging. Sequencing the tumor's DNA on a panel of known cancer-related genes may help clarify the cancer's origin and in this way assist the clinician in determining treatment or prognosis.
More cancer patients will have a treatment team rather than just an oncologist
Dr. Jennifer Morrissette:
It’s not going to be one physician making all the decisions. Cancer treatment has gotten much more complex. Because of the availability of multi-gene testing, you need a group of people with different types of expertise to make the best decision for a patient.
In addition to the team directing care for the appropriate approach—whether it's surgery, radiation, chemotherapy, pain management—now there is also the genetic component.
Being able to sit in a room with people from the lab who can talk about what the result means, having the oncologist say ‘Let me tell you about my patient,’ and a clinical geneticist suspecting that there may be an inherited predisposition.
Then, they walk out with a consolidated treatment plan for that patient.
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