President Obama launched a Precision Medicine Initiative in his state of the union address yesterday to “bring us closer to curing diseases like cancer and diabetes”. So what is Precision Medicine, and what effect could it have on patients’ lives and healthcare costs? We asked Dr Ger Brophy, Chief Technology Officer of GE Healthcare’s Life Sciences business.
“Precision medicine means, in any setting, rich or poor, providing the best care for each patient by using insight from all the available actionable data. This is not treating each person with a ‘personalized’ therapy, but means systematically combining data to help make clinical decisions that improve patient outcomes. It is the future of healthcare,” Brophy says.
When physicians evaluate patients, they intuitively consider multiple parameters, such as patient age and disease stage: managing the same stage of disease in a 45 year-old might not be the same as in an 85 year-old. Even considering just disease stage and patient age, physicians make different conclusions: e.g. one would not likely use aggressive therapy for an older patient with early stage prostate cancer, but for a young patient with the same stage disease, it might be appropriate. Aside from age, basic information such as patient preference, lifestyle, family history, and any other diseases patients has, are also part of treatment planning. With recent advances in tools such as DNA sequencing, gene expression analysis and molecular imaging, the full picture can now include insights into the biological drivers for disease states and subtypes. Precision medicine takes in all this information and redefines the a broadly defined disease to a much more specific profile. Therapies are then designed to treat a very specific profile much more effectively than less targeted approaches have given in the past.
“We are used to single parameters, such as the size or genotype of a lesion,” Brophy says “It is more difficult is to bring together multiple pieces of information in a quantitative, reproducible way to give a more precise answer to whether a patient will respond or not to a therapy. But this is the future of medicine. Systematically combining multiple pieces of information is complex, but is integral to making improvements to healthcare.”
GE’s work in Precision Medicine is currently focused on certain disease types within cancer and neurology. In cancer, for example, GE’s MultiOmyx technology creates a “digital molecular map” of a tumor, giving each cancer cell an “address” and allowing for graphic representation of its protein expression. Matching this map to likely outcomes, or clinical information, gives researchers and pathologists a more accurate representation of the exact characteristics of the cancer and helps clinicians make a more precise diagnosis. It also allows them to identify patterns in the tissue by analyzing each cell and biomarker individually, or as clusters, and thus get a level of understanding of the disease biology not achievable via traditional methods. With this deeper understanding of the tumor at a cellular level, experts can cross-check with known characteristics such as metastasis, mortality, response to therapy and others, and help guide better treatment choices for patients. Clearly powerful technologies such as these also have a place in medical research in addition to their usefulness in the clinic.
“Bringing precision medicine to communities and to individual patients is difficult,” Brophy says. “A big driver is cost. These are often costly diagnostics, and very costly treatments. Part of providing innovative diagnosis and treatment is doing so affordably for healthcare systems, and achieving results that justify the expenditure. Juggling cost with quality of care is not easy: physicians, healthcare providers, payers, industry, pharmaceutical companies and governments need to work together to make it happen.”