Discussing Personalized Medicine at #ACCC2014

ACCC’s recent 31^st National Oncology Conference featured 45-minute “think tanks,” supported by a grant from Genentech, on four hot topics in oncology. This is the third in a four-part ACCCBuzz blog series recapping these discussions from Think Tank facilitator, Joseph Kim, MD, MPH, of MCM Education.

The era of genomic personalized medicine is finally upon us and oncology professionals working in the community setting are delivering personalized care to cancer patients. At the 2014 ACCC National Oncology Conference, a Think Tank discussion focused on current trends and the future direction of personalized medicine.

Personalized medicine in the field of oncology can be defined as “the use of molecular diagnostics and genome analysis to select targeted therapies designed to treat cancer.” Some may refer to this as precision medicine and others may insist that the phrase “genomic” should be included to indicate that the level of personalization that is being offered today is based on the results of genomic sequencing data and identified mutation markers.

Targeting Treatments with Precision

Predictive biomarkers are being used to identify cancer patients who may respond to certain targeted therapies or to identify patients who may be resistant to other therapies. This allows oncologists to focus their treatment strategies by using drugs that have been approved by the FDA based on results from molecular biomarkers or companion diagnostic studies. This laser-focused approach to cancer care has led some to refer to this practice of medicine as “precision medicine” instead of personalized medicine. Since 2005, the FDA has been providing guidance in the area of personalized medicine for researchers, clinicians, and industry.

The Role of Biopsy

Of course, to perform highly specialized molecular testing on cancer biopsy samples, pathology labs must have access to adequate tissue. Think Tank participants agreed that this continues to remain a challenge in the community setting because so many physicians performing diagnostic biopsies are still only obtaining enough tissue to establish a diagnosis and are not obtaining extra tissue for molecular mutation testing. To further complicate matters, health insurance companies are not always providing reimbursement for certain mutation tests, so some hospitals are not performing critical tests that may be the gateway for personalized targeted care.

Ongoing Research

A growing number of academic research centers are establishing “Cancer Centers of Genomic Personalized Medicine” that are staffed with experts trained in tumor genetics, translational science, and bioinformatics. Think Tank participants noted that cancer centers in the community may not have staff who are trained in this highly specialized areas, but they are forming collaborations with research centers so that they can coordinate care for their patients and also identify those who may be appropriate candidates for clinical trials studying experimental therapies or combination approaches that target multiple genetic mutations.

Big Data Analytics

Some academic research centers are exploring the use of supercomputers like IBM Watson to analyze a wealth of information and identify a personalized approach to treating cancer. An example is the Memorial Sloan Kettering-IBM Watson Collaboration where oncologists are working with Watson to go through massive quantities of clinical data and published research to form actionable clinical practice for specific cancers. The New York Genome Center (NYGC) IBM Watson collaboration is looking at ways to leverage genomic research as a tool to help oncologists accelerate how they may more effectively deliver personalized care to patients with brain tumors and other complex diseases.

Conclusion

Personalized genomic medicine is here to stay and will dramatically alter the treatment strategies in cancer patients who have identifiable mutation markers that can be targeted with specific therapies. As cancer centers in the community develop treatment pathways based on biomarker and genetic mutation test results, they will be more effective in delivering care that is both evidence-based and potentially less toxic to patients.

Stay tuned for Think Tank #4 Discussing Molecular Tumor Boards at #ACCC2014.