Broadly defined, precision medicine is about the personalization of care. Yet on a practical level, precision medicine can take on different forms in different subspecialties in healthcare. In modern oncology care, it's largely about getting the right drugs to the right patient at the right time.
There's also some early evidence that more efficient targeted medication therapies can help to drive down pharmaceutical costs, in addition to the ever-important mission of improving patient care.
Dr. Michael Thompson, co-director of Aurora Oncology Group, precision medicine in Milwaukee, Wisconsin, said oncology drugs in particular require close maintenance. Now, with the Human Genome Project affording healthcare professionals a window into what makes the body tick, there's a greater understanding in oncology of not just the human genome but of disease genomes -- allowing the maintenance of drugs with increased specificity.
"That's a concept we all intuitively get," Thompson said. "What we're concentrating on in oncology are the molecular drivers of disease, and doing molecularly targeted treatments."
Some of the treatments that are possible in oncology using precision medicine target endocrine markers, found in malignant tumor cells producing parathyroid hormone-related protein. Breast cancers are now being treated with such therapies.
"Similarly, half of melanoma patients have B-Raf alterations that are potentially amenable to being targeted by inhibitors," said Thompson. "You can have mutations or other alterations that are present in cancer but don't drive the tumor. Now we routinely screen patients for molecular targets."
Dr. Jim Weese, vice president for Aurora Cancer Care and an advocate of Aurora Health, said many of the precision medicine therapies in the oncology space are developed for people with advanced disease. In the past, people were treated with chemotherapy and may have eventually gone to hospice or some form of palliative care.
Now, once the molecular profile is done, patients are often found to have potentially treatable diseases, and a reasonable expectation that they're going to see a positive effect from targeted therapies.
"The difference is, molecular treatments tend to be new drugs, so they tend to be very expensive," said Weese. "From the hospital side, it's important patients are evaluated properly, if the drug is appropriate on a given patient. The problem is, if you use the drug inappropriately, you waste a lot of money and a lot of time on a drug that likely won't have any effect."
THE INVESTMENT, THE RETURN
As for the capital investment required to enact effective precision medicine approaches, the money required -- and the projected investment -- are only now beginning to be understood. Cost/benefits data is starting to trickle in, and precision medicine trials appear to have neutral cost, or a slight cost benefit.
"Most new drugs are highly expensive," said Thompson. "The patient can benefit, and if we can avoid giving drugs to people who don't need it, that saves money and saves the patient toxicity. There's two ways of approaching costs: getting the drugs to the right person, but also avoiding inappropriate medicine and toxicity."
"The capital investment is quite variable," said Weese. "We felt it was important to have a data management system that would help us look at the identified patient with a given profile to see how they responded to a given drug. The reason that's important is because if you want to use a drug that costs $10,000, it's nice to tell a patient that of 10 prior patients treated with this, nine of them had a strong response. So you could reasonably justify having that type of expense.
"On the other and, if nobody responded, you save the expense of utilizing that drug in a given patient."
One likely benefit of precision medicine to oncology care is the time saved for clinicians. If an oncologist was left to their own devices to consider a single patient, it would easily occupy anywhere from two to five hours of their time, said Weese. By putting together precision medicine clinics, that oncologist can now deal with many more patients and be more adept at analyzing which medicines may be appropriate.
"It depends on how much you silo things," said Thompson. "When we were doing it before, everyone was ordering these tests anyway -- we just didn't have a centralized, coordinated way to do it. Now we can give a dashboard to our leaders on what's happening, and problem-solve in weeks' time rather than years later."
With pharmaceuticals comprising a significant percentage of the national GDP, precision medicine has shown potential to drive down costs, and combined with the increased care quality, it has started a movement in oncology to tackle disease in a much more targeted manner.
"We're able to help a lot of patients," said Weese. "In a lot of ways it's going to dramatically alter the way we treat cancer."