Individualized Medicine: Making an Impact
Individualized medicine is now a focus of research and clinical implementation at medical institutions across the globe. Mayo Clinic in Rochester is no exception, with researchers and physicians already using genomic data to aid in the diagnosis and treatment in a range of key areas, including oncology and mental health, among others. According to the Mayo Clinic, some of the benefits of individualized medicine — also called personalized or precision medicine — include improved molecular targets for cancer treatment, better prevention of disease using a molecular approach, reduced medication side-effects through pharmacogenetic testing, and reduced healthcare costs over time.
Holly, a breast cancer survivor and a patient at Mayo Clinic, was diagnosed with breast cancer in 2013. Oncologists took a biopsy of her breast tumor tissue, and the tumor was genetically sequenced.
“The sequencing information from the breast tumor is allowing us to look across the genome at abnormalities that are associated with no response or poor response to chemotherapy,” said Matthew Goetz, an oncologist at Mayo Clinic.
This genomic sequencing assisted in Holly’s cancer remission, and also provided valuable information for future treatment of similar breast cancer patients. “Down the road if I do have a recurrence,” said Holly, “they would have studied how my tumor tissue responds to different chemotherapies.”
Educating patients and professionals
While individualized medicine is new to patients, it also is a new treatment option for many healthcare providers.
“Genomics is something relatively new. [Providers] may have had genetics in medical school, but it’s been a while for many of them,” says Caer Vitek, education program manager at the Mayo Clinic Center for Individualized Medicine.
With the increased utilization of individualized medicine in healthcare, educating healthcare providers and making the implementation easier for physicians, nurse practitioners, physician assistants and nurses will improve patient outcomes.
“That means if the individual has had something called pharmacogenomic testing — understanding how their genes influence their drugs — then the provider may get a pop-up alert saying: Adjust the dose, raise the dose, lower the dose, or don’t use this medication at all,” said Vitek.
Dr. Wang, a professor of pharmacogenetics at Mayo Clinic, notes that genetic sequencing and individualized medicine is also being used to determine dosages for treatment of Acute Lymphoblastic Leukemia (ALL). According to Dr. Wang, some of the medications currently used in ALL treatment have severe side effects that can occasionally become fatal. If a patient has a genetic defect in their gene, it may cause severe toxicity due to the medication. By using genetic sequencing, doctors can see if a patient has the genetic defect before determining their dosage. If the physicians are aware of this beforehand, then the side effects and possible toxicity of the medication can be avoided.
“We want to understand why and how genetic variation might result in different function of those genes in these critical pathways; pathways determining the concentration of the drug in your body or determining how the drug might execute its functional action in your body,” said Dr. Wang.
Cost still an issue
With increased research and clinical implementation, individualized medicine is becoming more affordable than in previous years. However, individualized medicine is still relatively expensive, and genetic testing is not typically covered by insurance companies. According to Mayo Clinic, the funds for the individualized testing is up to the patient to cover out of pocket, and it is difficult to predict what the costs will entail. Along with the genetic sequencing, a genetic counselor is usually required to assist the patient in understanding the complex and often intimidating nature of genomic medicine.
White House Initiative
In 2015, former President Barack Obama announced a $215 million Precision Medicine Initiative to expand the implementation and understanding of individualized medicine.
“If we start today, seize this moment, and the focus and the energy and the resources that it demands, there is no telling how many lives we could save. And every single one of those lives matter,” Obama said in 2015.
The initiative is firstly focused on the National Cancer Institute (NCI) furthering research in relation to improving cancer treatments. The Precision Medicine Initiative has a long term goal of bringing individualized medicine into each and every aspect of healthcare. To achieve this large-scale goal, the National Institutes of Health (NIH) aims to gather biological samples and genetic sequencing data of 1 million patients across the United States.
This information will be used in research to study disease risk and occurrence among individuals, as well as improved preventative measures for greater overall patient health.
Obama noted, “And that ultimately, is one of the most promising aspects about this — making sure that we’ve got a system that focuses on prevention and keeping healthy, not just on curing diseases after they happen.”
Alec Johnson is a student at the University of Minnesota Rochester. He wants to pursue a career in emergency medicine as either a physician or a physician assistant.
Cover photo courtesy Mayo Clinic