Moores Cancer Center among precision medicine pioneers

When President Barack Obama touted the development of precision medicine in his recent State of the Union address, a chorus of experts weighed in on the feasibility of the initiative. But for some healthcare facilities, the use of genomics to improve the treatment and prevention of diseases is already a reality.

At the University of California San Diego Moores Cancer Center, for example, cutting-edge treatments have put into practice Obama's vision of a "new era of medicine, one that delivers the right treatment at the right time." Its Center for Personalized Cancer Therapy provides patients with molecular testing of their tumor's genetic profile, then submits the findings to UC San Diego's Molecular Tumor Board to review and recommend the best course of treatment, according to the center's website.

"Probably cancer's at the forefront for trying to use precision medicine or personalized therapy," Razelle Kurzrock, M.D., director of the Center for Personalized Cancer Therapy, told FierceHealthcare in an exclusive interview, adding that since the program began in 2007, "What's happened with technology is nothing less than breathtaking."

The field has grown leaps and bounds just in the last few years, Kurzrock said, with a much larger number of genomic tests that are available for cancer patients. And while precision medicine is going strong at her facility, she thinks Obama's speech will help fuel further strides in the field.

"Any time someone at the level of president addresses something that is important to the scientific or medical field, it does galvanize people," she said. "I think that the president paying attention to it is really terribly important."

The for-profit Hospital Corporation of America's (HCA) Sarah Cannon Research Institute runs 75 cancer centers across the United States and United Kingdom and is another organization that's jumping into precision medicine in a big way, Forbes reported.

After it was overwhelmed by the task of tracking late-stage cancer patients' clinical and genomic data in a clinical trial two years ago, HCA enlisted the help of a start-up to orchestrate a precision medicine initiative on a larger scale. The software platform will allow doctors "to measure the impact of a tailored treatment in conjunction with a patient's history, other treatments, biopsies, side effects and other relevant clinical information that reside in an electronic health record," according to Forbes.

Even if precision medicine initiatives receive adequate funding, however, a variety of cost-related barriers may mean many patients will lack access to such specialized treatments, Steven Rosen, M.D., an oncologist at City of Hope in Duarte, California, told the Los Angeles Daily News.

"The complicated issue is that the [Affordable Care Act] has done many wonderful things, but one of the things it hasn't done is making the latest technologies available to patients," due to narrow provider networks, he told the newspaper. "The hope is that in the future, for almost all cancer patients, we may be more precise in treatments."

Meanwhile, Kurzrock said the challenge for doctors using precision medicine at her facility is most often related to procuring the right drug to interfere with a tumor-causing abnormality in a patient's DNA. It can be difficult to match up patients with clinical trials due to logistics as well as increasingly strict criteria that patients must meet, she said, adding that it helps that "the [Food and Drug Administration] has approved a lot of these targeted drugs over the last few years."

Also, while it's possible that narrow provider networks may limit individual patients' ability to receive treatment at the Center for Personalized Cancer Therapy, "we're actually experiencing an increase in patient volume," she said.

As for pursing precision medicine for a population beyond cancer patients, such a broad-based initiative will first require drug-testing and insurance reforms, Reuters reported, as well as an ambitious national database of genetic profiles to allow researchers to examine correlations between patients' medical histories.

Any successful precision medicine initiative must also focus on prevention, strategically target diseases and set standard definitions and metrics for defining diseases, Spencer Nam, a senior research fellow at the Clayton Christensen Institute for Disruptive Innovation, wrote in The Health Care Blog.

To learn more:
- Visit the Center for Personalized Cancer Therapy website
- read the Forbes article
- here's the L.A. Daily News report
- check out the Reuters article
- read The Health Care Blog piece

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