President Obama gave a shout out to precision medicine during his State of the Union speech in January.
Obama launched his Precision Medicine Initiative with $215 million and an eye toward pioneering a new model of research that targets treatments to the genetic profile of each patient’s cancer.
“Most medical treatments have been designed for the ‘average patient,'” reads a fact sheet from The White House. “As a result of this ‘one size-fits-all-approach,’ treatments can be very successful for some patients, but not for others.”
While it may be an unfamiliar concept to many Americans, scientists at Oregon Health & Science University’s Knight Cancer Institute have been pushing the frontiers of precision — or personalized — medicine for years. I spoke recently with Dr. Tomasz Beer, deputy director of the Cancer Institute, about exactly what precision medicine means and how it could impact the future of medicine. Here are five takeaways:
- Genomic sequencing, both of the host and the cancer, may be at the center of personalized medicine, but it’s not the whole story. “Our genetics and tumor genetics define an incredible wealth of information, but it’s not all,” Beer said. Measuring immune activity will also play a big role. “Immuno-scores” measure types of immune cells that have infiltrated the cancer. “In the future, I would imagine different types of immune therapy prescribed based on the makeup of the tumor immune reaction,” Beer said.
- Precision medicine is in its infancy. “There is a pretty big distinction between the tools actually available today and what we hope to see,” Beer said. “That’s a key message to the public. Every time we do one of these stories, a third of my patients say, ‘Where’s my personal genome?’ A lot of people need things now because they’re ill, and we don’t want to raise their hopes inappropriately. … We have a long way to go before it’s a routine part of health care for everybody.”
- Precision medicine raises ethical issues. Personal genomes reveal predispositions and risks, not just active diseases. Said Beer: “It’s wonderful if you have an effective and safe solution. That’s the holy grail. For some things, we don’t have effective preventions. So knowing you might be predisposed may not be that helpful. These things are relatively easy ethically when someone already has advanced cancer. When you start going backwards to individuals living a happy life — I’m not advocating ignorance, but it can be blissful knowing nothing’s wrong.”
- OHSU will be vying for grants related to Obama’s initiative. “This is right up our alley,” Beer said. There may also be opportunities to collaborate, since collecting data from large numbers of patients is difficult and expensive for any one institution to do on its own. “The president appropriately is seeing the science advancing quickly enough, where it’s more clear and the nation can rally around it,” Beer said.
- To some extent, every encounter with a good physician is personalized medicine, personalized “to your values and priorities, history and condition,” Beer said. “The dream is one day there will be a genomic, or comprehensive, tool to markedly increase that personalization.”
Portland Business Journal