The treatment of chronic diseases needs a revolution.
We know that two people with the same disease can have radically different experiences. Take Lupus, for example – many patients with the condition experience a different combination of physical symptoms. Because of this, we know that a “one-size-fits-all” approach to disease treatments is not always effective.
The question is therefore: how do we make treatment more attuned to individuals and the underlying, biological causes of their disease? How do we split up a group of patients with the same disease and match them with the treatment they each need?
The answer? Precision medicine.
Only coined as a term in 2009, precision medicine strives to understand the biology of a disease. It allows us to split a group of patients with the same disease into smaller variation groups based on biological indicators – known as biomarkers – to determine exactly what is causing their disease and causing their symptoms.
One area where this is already happening is oncology. Precision medicine provides many cancer patients with targeted drugs so that they receive the coordinated treatment they need for their tumor type. This reduces the use of treatments that may be less effective and their possible side effects. But with chronic diseases it is more difficult. More often than not, there is a definite time when cancer is diagnosed and then treatment begins. With a chronic illness, you can have symptoms for years and try multiple treatments before getting a diagnosis. The complexity of the conditions means that they can present with many different signs and different underlying causes.
That said, we are making progress. We actively pursue precision medicine in the treatment of chronic diseases and we are increasingly aware of the challenges and the wide range of possibilities.
The possibilities
The main problem we can solve with precision medicine is the one-size-fits-all approach to treating chronic diseases. By understanding the biology underlying a disease, we can increase the likelihood that if you pair a patient with a particular drug that targets their biology, they will respond to it. Not only would this make the treatment itself more effective, but it also saves patients the side effects of treatments they don’t actually need. In the long run, we can also reduce the waste of healthcare materials and resources.
Technological progress offers a huge opportunity to realize this. For example, machine learning and artificial intelligence allow us to analyze extraordinary amounts of data, allowing researchers to view a patient’s entire biological landscape.
The challenge
To identify different subgroups of a disease, we need data from large numbers of patients. It can be a challenge to collect this data in hospital settings, for example through imaging, blood and genetic testing, and it is also a challenge to ensure that it is accessible to researchers
Where are we going?
It is worth recognizing that we have come a long way. It’s been a little over three decades since the Human Genome Project was launched to discover what underlies human health and disease at the genetic level. Since then, the industry has seen increased regulation and developed a framework for sharing genomic and clinical data, while protecting patient privacy. The knowledge we have gained has already transformed pharmaceutical research and development, offering new hopes of treatments for patients with a range of chronic diseases.
In 2015, the cost and time of per genome sequencing — a critical part of the precision medicine approach — dropped from about $1 billion in 2006 (in 6-8 years) to only about $1,000 (in 1-3 days). And this year, the complete gap-free sequence of the human genome has finally been published. We are really making great progress.
We have also seen a much greater availability of big databases over the past 10 years. Building on this to find better ways to collect and analyze data will be critical to the advancement of precision medicine. Making sure these are made available to the entire community is where our focus should be.
We also need data to collect from: enormous numbers of patients. We need patients with chronic conditions who are made aware of and also willing to participate in research studies with the support of their clinicians.
Revolutionizing healthcare with precision medicine will undoubtedly be a major challenge. But if we can work together – if the clinical, diagnostic, pharmaceutical and academic communities can work together – it’s achievable. We may one day aspire to live in a world where treatments can slow, stop, and even reverse chronic diseases.
About the author:
Adam Platt is VP, Translational Sciences and Experimental Medicine at AstraZeneca.