Wednesday, October 10, 2018
Precision medicine (sometimes called “personalized medicine”) offers some of the most promising new treatments for cancer. Recognizing its potential, the Obama administration launched a $215 million research initiative in 2016. But this enthusiasm hasn’t translated into public awareness. In a recent survey of more than 1,000 Americans, 66 percent had never heard the terms “precision medicine” or “personalized medicine.” While government officials and the medical community celebrate advances, cancer patients often struggle to navigate a treatment landscape that increasingly resembles science fiction.
What is Precision Medicine?
Rather than a specific treatment or set of treatments, precision medicine is a novel approach to health care. It aims to find a targeted therapy for the individual based on factors such as genes, biomarkers, and environmental factors.
In oncology, examples include biomarker testing and immunotherapy. Biomarker testing can analyze a tumor sample to create a more specific treatment plan. This method has led to new classifications of different types of cancer, such as HER2-positive breast cancer. Patients with the HER2 protein benefit from different therapies than those with other types of breast cancer, allowing for more targeted treatment. Immunotherapy utilizes a patient’s own immune system. This includes modifying T cells to fight cancer and even creating cancer vaccines.
Weighing the Risks and Benefits
The advances above are undoubtedly exciting. However, precision medicine is a field still in its infancy. Like any emerging science, its risks and limitations aren’t well-understood, and it isn’t always accessible to patients.
In some cases, the barrier isn’t the patient’s lack of information: it’s the doctor’s. In a recent “Frankly Speaking about Cancer” interview, one man described his struggle to access immunotherapy. After doing research online, he decided to ask his oncologist if immunotherapy was an option – only to find out that his doctor didn’t know what it was. He was eventually able to participate in a clinical trial after finding another oncologist.
Many practitioners are also hindered by a lack of knowledge about genetics and genomics. In oncology, genetic testing is used to find genes associated with cancer (such as the BRCA genes), while genomics can be used to study a tumor and isolate its cause (such as the biomarker testing mentioned above). Some practitioners attended medical school when both were emerging sciences, leaving them unprepared for the increasingly vital role genetic and genomic testing play in modern medicine.
As a result, they may not be qualified to interpret test results. This can lead to misdiagnosis, unnecessary anxiety, and occasionally inappropriate treatments. Doctors may turn to a medical geneticist instead, but that’s assuming they can find one nearby. Demand for medical geneticists outpaces supply, especially in areas that aren’t home to a major research hospital.
Another hurdle is the fact that most precision medicine treatments are available only through clinical trials. While clinical trials can be a great (or even the best) option, patients interested in precision medicine trials may need to travel long distances and experience unpredictable side effects.
Precision medicine involves risks and uncertainties, but it remains a promising avenue for cancer research. It can offer different treatment options for cancers that don’t respond well to traditional courses of chemotherapy, radiation, and surgery. Ultimately, it falls on doctors to make sure patients are informed and comfortable before deciding to try this new approach.