By Liam Selfors
While cancers, among many complex multigenic diseases, are often mechanized by precise genetic and environmental underpinnings, they have been traditionally categorized and treated by their location (ie. ‘skin’ cancer or ‘breast’ cancer). Some companies would like you to believe that every drug works for every patient, this is unfortunately not the case. Recent pursuits in precision medicine seek to disband this myth with a data-driven infrastructure that allows clinicians to treat patients with complicated diseases on an individual basis.
Variability in the efficacy, toxicity, side effects, therapeutic window, and interactions between patients who are prescribed the same drug create a need to nix the ‘one-size-fits-all’ treatment approach to make way for modern methods that are ultimately safer and more efficient.
Precision medicine is a relatively new field that combats these diseases with systems of treatment and prevention that are centralized instead on the individualized data of each patient’s unique genetic and environmental variability.
To better understand the role Wisconsin plays in this emerging field, Wisconsin’s leading precision medicine researchers and experts led a panel discussion around what’s next for precision medicine research and how it will impact Wisconsin’s biohealth industry. Amongst each panelist’s presentation four main topics emerged, ultimately focused on building a clinical infrastructure that can quickly and efficiently assess the features of each patient’s unique situation that will influence treatment on an individual basis for complex, multigenic diseases:
- Increasing the scope of information considered in diagnoses – Patient diagnoses can change widely based on links between data sets from several areas of study. Differences in the DNA in a patient’s genome, the ways their genome is regulated, transcribed and expressed, the bacteria that live on or inside a patient, and the things a patient has been exposed to throughout their life can all have important applications in developing a directed treatment.
- Conducting clinical trials with an epigenetic infrastructure in mind – With multiple disease types and subtypes, it’s essential to accurately determine whether a targeted therapy against a specific genomic abnormality works. Clinical trials are essential to enable researchers to determine a medication’s efficacy and the mechanisms that underlie medication failure.
- Continuously updating digitized treatment models with smart data integration and knowledge management systems – In order to create some sort of stratification in clinical trials, big data is necessary to not only obtain the necessary data but to maintain models that can be used for future diagnosis. By utilizing machine learning techniques that continuously add to and update existing models, a fully digital semantic integration of heterogeneous data can be developed that gives clinicians the power utilize mathematically calculated insights to assess all aspects of complexity in a patient’s life.
- Implementing pharmacogenetic preemptive testing to remain one step ahead of disease – Nearly one-in-five prescriptions are written based on guesswork rather than attainable insights on actionable pharmacogenes. With wide applications in fields like oncology, psychology, neurology, epigenetics, cardiovascular disease, infectious disease, and many others, it’s more necessary than ever to evaluate individual risk before symptoms arise. Preemptive pharmacogenetic genotyping can broadly base-test all genes at the time when the risk for disease is identified to decrease the turnaround time for gene spectrum analysis to basically zero.
While the development and implementation of these overly-informed systems appear expensive, pharmacoeconomic analyses suggest huge benefits to cost-efficiency and quality of care down the line. Prescriptions will be several times more effective, researchers will a greater understanding through more complete data, and disease survival rates will ultimately rise.
Wisconsin is leading much of this effort to revolutionize precision treatment integration. In addition to UW’s role in developing a breakthrough pediatric leukemia treatment marking the first FDA approval of a CAR-T cell therapy, a $5.4 million grant was recently awarded to the UW School of Medicine, Marshfield Clinic Research Institute, and Medical College of Wisconsin for precision medicine research.