The Continued Push Toward Targeted Therapies
In his recent State of the Union address and again a few days later at the White House, President Barack Obama outlined his $215 million Precision Medicine Initiative. The president’s hope is that with increased funding and attention, scientific research will continue to progress so that providers can deliver “the right treatments, at the right time, every time to the right person.”
Such a push to understand and treat disease on a molecular level isn’t new to the Nashville community. With robust oncology programs at Vanderbilt and Sarah Cannon, the area’s researchers and physician-scientists have been actively involved in an array of new discoveries and drug development for many years.
Recently, Holli Hutcheson Dilks, PhD, director of Personalized Medicine Operations for Sarah Cannon Research Institute (SCRI) and Andy Corts, chief information officer at SCRI, discussed the merging of science and technology to target treatment protocols and match patients to clinical trials.
Asked to explain the difference between ‘personalized medicine’ and ‘precision medicine,’ Dilks said the terms, along with molecular profiling and genomics, are sometimes used interchangeably, depending on the institution. At Sarah Cannon, however, Dilks said she thinks of precision medicine as being very specific or precise to a particular tumor or genetic variation. It’s medicine on the molecular level. Personalized medicine, she continued, is the larger umbrella taking in all facets of what is best for a particular patient, which includes the entire phenotype … personal preferences, co-morbid conditions, molecular information, psycho-social considerations, and more.
“At Sarah Cannon, we’ve been practicing personalized medicine since our inception,” Dilks said.
The precision medicine focus is somewhat newer. “We started a molecular profiling program about two-and-a-half years ago. We look at the DNA sequence of people’s tumors to determine if there is a mutation, and if so, is there standard-of-care therapy or a clinical trial,” she said of trying to match patients to newer treatments and trials if they exist.
Dilks said treating disease on a molecular level has quickly gained momentum over the last few years, particularly in the field of oncology. “Six of the last 22 FDA-approved new molecular entities for solid tumors are targeted therapies,” she noted.
Traditional therapies have typically been directed at rapidly dividing cells. While Dilks, a human geneticist, said many of those are cancer cells, not all of them are (think hair follicles, skin cells). When cutting a wide swath in the quest to kill the rogue cells, there can be collateral damage to healthy cells. With precision medicine, the therapy is targeted specifically to address a particular mutation and the collateral damage lessened.
“It’s really exciting for patients because these options are more specific, have lower side effects and are more powerful than some of the traditional therapies,” Dilks said. “Now you’re going in with a scalpel instead of a sledgehammer.”
Dilks noted that about 30-35 percent of clinical trials, both at Sarah Cannon and across the industry, are for targeted therapies … a number she expects to only increase. However, Dilks was quick to add more research needs to be done not only to discover additional therapies but also to figure out how to circumvent relapses. To this end, she said the field is moving into studying the effects of combination therapy to attack cancer on various fronts.
“We have to have this learning system. Everyone benefits from that,” Corts said. Dilks added, “Right now – with this rapidly changing field – for some types of cancer, a clinical trial should really be the first line of therapy … the first thought, not the last.”
However, what holds the most promise can also cause the most headaches as clinicians try to keep pace with the latest findings and trials. That, Corts said, is where technology steps in to help.
“From an IT perspective, this is such an exciting time to be in healthcare as healthcare and clinical care are becoming more data driven,” he said.
Daunting amounts of data come in daily, but it is just a bunch of facts and figures unless it can be put to use. In the fourth quarter of last year, Corts said SCRI selected Syapse, a precision medicine software provider, to help them harness that information and deploy it across Sarah Cannon’s network of cancer centers throughout the United States and United Kingdom.
“What they bring to the table is a genomic data model … a way to digest all that information,” Corts said. He added, “We also needed an information databank where we could access new discoveries as they occur.”
In addition to being able to pinpoint the best clinical trial for a patient given his or her specific genomic profile, Corts is also excited about the ability Syapse offers to do correlated analysis of trials. “Let’s say we put 100 people on a clinical trial … 90 did great, but 10 did poorly … but they all had the same biomarker so we need to drill into other pieces of the data,” he explained. “By mining that data, you can correlate different factors that led to that outcome.”
Ultimately, the rapidly expanding world of precision medicine has led to a growing national will … both scientifically and politically … to translate that knowledge into clinical care. “We have these capabilities, now it’s time to harness them and give patients the appropriate treatment at the right time,” Dilks concluded.
RELATED LINKS:
