The recent unveiling of the Precision Medicine Initiative during President Obama’s State of the Union address was a momentous occasion for this molecular pathologist. President Obama seeks to invest $215 million from his 2016 budget to improve the country’s ability to explore and leverage precision medicine.
So, what exactly is precision medicine?
Currently, most medical decisions and treatments are designed for the “average patient.” We have a one-size-fits-all model. This means treatments and medical advice for patients with similar health circumstances can be successful and accurate in some patients, but not in others. Precision medicine takes advantage of individual differences in a patient’s genetic makeup and environmental circumstances and applies this information to better inform medical care. The promise of precision medicine is that medical therapies can be “tailored” to individual patients with the hope of optimizing benefits and minimizing needless medical care and undesirable side effects.
Why this initiative and why now?
The Precision Medicine Initiative is a bold research effort. Its aim is to revolutionize the practice of medicine. The initiative is driven by two things happening right now: 1) Sequencing a human genome for a reasonable cost in a reasonable amount of time, and 2) Supportive bioanalytical technology to make sense of the complexity of that genomic data.
How can patients and physicians benefit?
Many patients can benefit from the application of precision medicine. The near-term aim of the Precision Medicine Initiative is to accelerate the application of precision medicine in cancer diagnosis and treatment. Currently, there are many tumor types, including but not limited to breast, lung, colon, melanoma, and leukemia that are routinely submitted for molecular testing as part of the standard pathology testing process. This testing is capable of generating a molecular fingerprint of the individual cancer that alerts physicians to what genes are driving tumor growth. This information provides opportunities to improve prognostic accuracy and tailor therapies to more accurately treat the patient’s cancer and minimize generalized side effects from toxic chemotherapy.
What’s happening at the UVM Medical Center?
The Department of Pathology and Laboratory Medicine at the University of Vermont Medical Center is collaborating with oncologists and the University of Vermont Cancer Center to develop molecular testing specifically for cancer. Pathologists will be able to submit the DNA from a patient’s tumor for analysis of twenty-nine genes that we know can be mutated in solid tumors. The twenty-nine genes were chosen for analysis because they are known to be medically-relevant for cancer care. Tumors that have mutations may qualify a patient for a precision cancer therapy that is either currently FDA-approved, or available through a clinical trial. Even if a test reveals that the genes in a tumor do not harbor mutations, this is still medically-relevant information. For example, targeted therapy can be harmful if it is not matched to a tumor with the correct mutation profile.
The medical community has slowly adopted elements of precision medicine over the last decade, but the pace at which precision medicine enters the clinic may accelerate with the new support from the federal government. The current effort towards the realization of precision cancer care locally will result in an infrastructure and knowledge base that will foster more rapid integration of cutting-edge precision medicine in other facets of health and disease across the entire University of Vermont Health Network.
Learn more: Read “Inside the Double Helix: What is Pharmacogenomics & How Will It Change Medicine?” by Dr. Sidiropolous.
Nikoletta Sidiropoulos, MD, is Director of Molecular Pathology in the Department of Pathology and Laboratory Medicine at The University of Vermont Medical Center.