By Ahmad Sabbagh '17
On January 30th President Obama announced a $215 million budget plan for a “Precision Medicine Initiative” designed to usher in a new age of personalized medicine that will take into account a patient’s genes, environment, and lifestyle for more individualized and effective treatments. The new Initiative will expand past today’s advances in DNA sequencing and cancer genomics by partnering with the scientific, medical, health, and societal communities in both the public and private sector in order to support new clinical trials and studies and employ new technologies to propel understanding of health and disease.
Despite the excitement surrounding the Initiative, which has managed to receive bipartisan support from Congress, it was met with some skepticism from the public. Some concerns arose as genetics so far have failed at effectively predicting disease while factors such as environment, culture, and behavior have served as much better indicators. Other concerns have risen from doctors who are ill-equipped to read genetic tests, especially those who earned their medical degrees before the human genome was sequenced. Still others are concerned with the economics of the Initiative and what precision medicine entails for the future costs of healthcare and medicine.
In spite of these concerns, precision medicine has been revolutionary in its short but recent development. Spearheading the advances in precision medicine are the newly developed basket studies, studies in which patients of different tumors that have the same underlying genetic mutations are grouped together for clinical trials. By tackling the mutation rather than the tumor, the patient receives an individualized treatment rather than a “one size fits all” treatment.
These basket studies have only become recently possible thanks to advances in gene sequencing that have made it accurate and cheap enough for doctors to routinely look for known cancer-causing mutations in tumors. Although these basket studies have resulted in some failures, they have also resulted in some unprecedented responses, including response rates of 50 or 60 percent compared to conventional therapy response rates of 10 or 20 percent.
Yet the picture is not all so rosy, as these studies are still in their early days of development. Moreover, researchers typically conduct basket studies without control groups of standard treatment patients to compare results. This poses a problem, as it can be difficult to determine whether side effects during treatment come from the drug, cancer, or another disease. The effect of a treatment must be enormous and unmistakable in order to rule out any results from chance.
Fear not however, as these concerns still allow hope for the future. While researchers continue to develop these studies and methods of testing, the result sharing that is an integral part of the Precision Medicine Initiative as well as other future initiatives should allow these studies to advance quickly and become more accurate while growing larger in scope. Ultimately, these basket studies spell hope for the future of medicine as they lead the revolution towards more personal and effective treatments.
Sources:
http://www.nih.gov/precisionmedicine/
http://www.nytimes.com/2015/01/29/opinion/moonshot-medicine-will-let-us-down.html
http://www.newyorker.com/tech/elements/problem-precision-medicine
http://www.nytimes.com/2015/02/26/health/fast-track-attacks-on-cancer-accelerate-hopes.html