As governments invest in a new era of medicine Vision investigates how precision treatment can change the world, genome by curated genome
Chances are that you have already experienced precision medicine. When an optician prescribed glasses to match your vision. Or perhaps when you gave blood and it was bagged by type to be matched to a compatible recipient.
But when it comes to impregnable disease such as cancer, treatment is traditionally a one-size-fits-all approach. Until now, an individual’s minute but critical genetic idiosyncrasies and mutations are often unexplored, when they could hold the key to why treatment is ineffective for some patients and triumphant for others.
The Precision Medicine Catapult launched by Innovate UK in 2014 as its latest technology and innovation centre estimates the current £14bn precision market for tests, therapies and solutions will grow to £60bn by 2020. Why? Simply because ‘a lot of drugs don’t work well for many patients’, it says.
According to Innovate UK, ACE inhibitors, a drug commonly prescribed to people with high blood pressure is found to be ineffective for 10-30 per cent of patients, whereas anti-depressants are ineffective for 20-50 per cent of people with depression.
A staggering 70 per cent of patients could be saved this kind of unnecessary treatment when it comes to prostate cancer; a disease currently treated by biopsy and imaging that leads to radiotherapy, chemotherapy, and hormones. Precision medicine uses a gene panel in addition to detect if the cancer is aggressive or slow growing – the former requires targeted chemotherapy based on genetic changes, but for the latter a ‘watch and wait’ policy is preferred.
We need a long way to go before we can commonly practice it (but it can) increase cure rates of many diseases and therefore save many lives
In the US, President Obama announced an investment of US$215m in the pillars of precision medicine: to investigate an individual’s genome sequence, microbiome composition, environment and lifestyle and then to use this map to predict more accurately which drugs work in which groups of people.
The Catalogue for Transmission Genetics in Arabs, part of the Dubai-based Centre of Arab Genomics is also pioneering the idea of ‘healthcare tailored to you’ with the largest ethnic-based genetic database worldwide that houses 1,600 records of genetic disorders and their related genes.
Efforts from the US and Dubai are typical of incredibly ambitious plans globally to harness huge quantities of data from a voluntary research cohort, store results safely on a secure database, and train doctors to interpret complex findings and feedback simply to patients in the name of precision medicine.
In China, the potential of its large populations of patients to deliver sprawling data sets that will validate tests means the scope for its new preventive medicine program will dwarf Obama’s project when it is announced in the five-year plan.
Dr. Chao-Nan Qian, professor and Vice President at Sun Yat-sen University Cancer Center says the hundreds of separate projects set up at China’s leading institutes to sequence genomes, identify mutations and gather clinical data has the potential to change the world in two ways.
‘We need a long way to go before we can commonly practice it (but it can) increase cure rates of many diseases and therefore save many lives, and significantly decrease the health care expense’, he says.
‘Currently, a small portion of our cancer patients get the benefit from precision medicine. Based on genotyping data, some of the patients can obtain survival benefit from targeted drug therapy.’
However, the benefit of genotyping data to support medical practice is limited, at least in the next ten years’, admits Dr. Qian. ‘Actually, our knowledge about genetic alterations affecting disease initiation and progression is very limited.
‘This is just the beginning of precision medicine. Much more efforts are needed in this direction before most of the cancer patients can take the advantages of precision medicine’.
The human genome project introduces some new wonderful disease based thinking but translating that data to an individual will require people skills
Although Dr. Qian says that clinicians do not need to re train as geneticists to increase their knowledge, Dr. Frank R Jones, President of the Royal Australian College of General Practitioners (RACGP) cautions that face-to-face patient care will be as important as poring over vast swathes of inscrutable data.
‘Doctors are trained as scientists who measure things – and that will be enhanced, but care is always about people and not just data collection and analysis.
‘The human genome project introduces some new wonderful disease based thinking,’ he says, (but) ‘translating that data to an individual will again require people skills. It is getting the mix right – between the appropriate use of technology and translating that into personalised contextual care.’
Australia’s National Health and Medical Research Council recently granted $7m to a five-year research project at the University of Queensland (UQ) that will analyse large genomic data sets from hundreds of thousands of people.
The analysis methods and tools developed to investigate neurological and psychiatric disorders including motor neuron disease and Parkinson’s disease is part of a data-driven medical revolution that UQ Vice-Chancellor and President Peter Høj likens to the inception of social media.
‘Big data technology created social media, and has transformed weather forecasting and mineral exploration,” he said at the March launch that placed Australia at the forefront of the precision field.
‘Transformation of the same magnitude is now coming to health care, as we move into the era of so-called personalised and precision medicine based on an individual’s genes’.