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Boston Globe: When treating cancer, precision medicine is not always so precise

The idea of precision medicine is a simple one: Customized treatments for individual patients based on historical data. In some cases, advances in delivering precision medicine to patients have already been made. Take John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston, for example. He used big data analytics to not only help his wife beat breast cancer, but also tweak her treatment plan to her specific needs.

However, precision medicine still has a long way to go, according to a Boston Globe article on using precision medicine to battle cancer.

The difficulty here, the article said, is that as a tumor grows it develops so many genetic changes that it’s difficult to identify the “driver mutation,” which is what causes the uncontrolled growth of the tumor. Because of this obstacle, it can then also be difficult to figure out what drug to use. The article describes trying to prescribe the most effective drug in this case as “shooting at a moving target” and further explains that even if doctors “correctly identify one driver mutation, another can emerge weeks or months later, making the previous drug regimen ineffective at fighting the tumor.”

The article tells the story of John Moore, 54, who could have been President Obama’s precision medicine initiative’s “poster child”. His tumors were shrinking and the cancer stopped spreading all because doctors were able to successfully match drugs to the cancer’s DNA. However, the good news didn’t last. Moore has advanced melanoma and it has spread to his lungs, the article said.

Lincoln Nadauld , M.D., director of cancer genomics at Intermountain Healthcare based in Salt Lake City, was quoted in the article: “The promise of precision medicine in cancer is that you’ll be able to find an actual driver mutation and match a drug to it … The problem is that it’s never quite as easy as we’d like it to be.”

Intermountain Healthcare is conducting a precision medicine study with 243 cancer patients. So far, the cancer patients in the precision medicine group have fared better after more than two years than those in standard therapy. The amount of time it took tumors to grow and spread in the precision medicine group was 23 weeks, the study found so far. In the standard therapy group it took 12 weeks. Researchers are still tracking patients participating in the study to see whether those in the precision medicine group live longer.

However, the articles concludes that, “setbacks like Moore’s show that genetic profiling of tumors is, at this point, no more a cure for every cancer than angiogenesis inhibitors, which cut off a tumor’s blood supply, or other much-hyped treatments have been.”

That remains to be seen, in my opinion. Data is constantly increasing and will benefit precision medicine efforts. I wouldn’t write-off precision medicine just yet.

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