At the start of the year in his State of the Union Address, US President, Barrack Obama announced the launch of the Precision Medicine Initiative – a $215 million dollar plan to improve the current state of cancer diagnosis and stimulate the development of oncological therapies for specific types of the disease. This follows the reclassification of cancer as a disease of the genome; a decision made in recent years, following completion of the Human Genome Project.
Traditional cancer therapies have treated the disease on an organ-by-organ basis, categorizing the illness by the site of the primary tumor, such as the lung, breast or brain. The Precision Medicine Initiative points to a more individualized way to treat cancer based on the underlying genetic aberrations at its core.
So how will the Precision Medicine Initiative affect cancer diagnosis and patient treatment options? According to the National Cancer Institute in the US, it’s focusing its efforts towards personalized medicine in four main areas:
Expanding precision medicine clinical trials in an effort to match the patient to the right therapy. While the National Cancer Institute has already begun a number of these trials, they hope to build upon the idea of personalized medicine in order to determine the best treatment for a specific genetic mutation, regardless of the site of the initial tumor.
Overcoming drug resistance by studying how tumors that once responded to treatment have built up a resistance to a drug, and continue to proliferate. This goal ties into the next part of the National Cancer Institute’s plan.
Developing new laboratory methods for research to better understand an individual patient’s tumor characteristics, and how those cells may respond to a specific treatment. The National Cancer Institute says this will involve increasing the number of patient-derived tumor xenografts, as well as other 2-D and 3-D human cell culture models used to study the disease biology.
Developing a national cancer knowledge system which would allow physicians to predict patient outcomes based on a wide variety of data available for a particular cancer type. The database would include genomic information about the tumor, which would also aid researchers and drug developers in the creation of novel, individualized therapies.
To further understand how the paradigm shift in cancer research, diagnosis and treatment will affect how drugs are developed and clinical trials are conducted in Canada, I spoke to Dr. Sian Bevan, director of research for the Canadian Cancer Society. Bevan has been with the Canadian Cancer Society for 6 years, and has a background in medical biophysics. Her previous role was as the team lead for research programs with the Ontario Genomics Institute.
How is Obama’s Precision Medicine Initiative affecting cancer care in Canada?
It’s important to remember that the idea of precision medicine isn’t brand new. There’s certainly an evolution and new tools have been developed that are really accelerating the pace of some of this. There are a lot of different examples of drugs in cancer that are now standard practice that you would put in the category of precision medicine. For example, Herceptin is a drug that you give to women with breast cancer who overexpress a particular protein, so that in and of itself is personalized medicine.
The genetics and genomics and all of these different ‘-omics’ technologies in particular, are certainly teaching us more and more about different diseases and cancers. There’s far more opportunity to be more and more precise with respect to the treatments that we’re giving patients to ensure that we’re only giving treatment to people we know will respond, and avoiding the side effects for people who are not likely to respond.