What’s Wrong With What We Have Now?

Would a teenage boy buy the same clothes as his grandmother? Probably not. But when they get sick, they’re likely to receive the same medical treatment, despite their many differences. And so will everyone else.

That’s because even the world’s best scientists and doctors don’t fully understand yet how different people develop disease and respond to treatments.

The result is a “one-size-fits-all” approach to medicine that is based on broad population averages.

This traditional practice often misses its mark because each person’s genetic makeup is different from everyone else’s, often in very important ways that affect health.

The advent of personalised medicine is moving us closer to more precise, predictable and powerful health care that is customised for the individual patient.

Our growing understanding of genetics and genomics – and how they drive health, disease and drug responses in each person – is enabling doctors to provide better disease prevention, more accurate diagnoses, safer drug prescriptions and more effective treatments for the many diseases and conditions that diminish our health.

Tailoring health care to each person’s unique genetic makeup – that’s the promising idea behind personalised medicine, also variously known as individualised medicine, precision medicine or genomic medicine.

Here is a list of 11 actual ways in which personalised medicine is allowing health care providers to improve patient care today:

• shifting the emphasis in medicine from reaction to prevention

• predicting susceptibility to disease

• improving disease detection

• pre-empting disease progression

• revealing additional or alternative uses for medicines and drug candidates

• customising disease-prevention strategies

• increasing patient adherence to treatment

• prescribing more effective drugs

• avoiding prescribing drugs with predictable side effects

• reducing the time, cost, and failure rate of pharmaceutical clinical trials

• eliminating trial-and-error inefficiencies that inflate health care costs and undermine patient care

As shown in the figure below, many patients do not benefit from the first drug they are offered in treatment.

Studies have linked these differences in response to the differences in genes that code for drug-metabolising enzymes, drug transporters, or drug targets.

The majority of patients, for example, have at least one DNA-based variation in the enzymes that metabolise half of the most commonly prescribed medicines.

The use of genetic and other forms of molecular screening allows the physician to select an optimal therapy the first time, thus avoiding the frustrating and costly practice of trial-and error prescribing.

Below are three concrete examples as to how personalised medicine is making a real difference for patients:

Blood Clots

Before the availability of genome-based molecular screening, the dosing of Warfarin, which is prescribed 21 million times a year in the United States alone, was a dangerous game in which too little of the drug could trigger more clots and too much could lead to excessive bleeding.

Since 2007, the U.S. Food and Drug Administration has recommended genotyping for all patients being assessed for therapy involving Warfarin.

Genotyping allows prescription of drug therapy regimens only to individuals expected to benefit from that specific drug at that specific dosage.

Colorectal Cancer

Metastatic colorectal cancer kills 50,000 individuals in the US every year, more lives than are lost to breast cancer and AIDS combined. Among the drugs most frequently used in treating colon cancer is cetuximab.

For colon cancer patients, the biomarker that predicts how a tumour will respond to certain drugs is a protein encoded by the KRAS gene, which can be now be determined through a simple test.

Because cetuximab is effective only in colon cancer patients with normal KRAS protein, treatment with the drug can be withheld from the 40 percent of patients for whom it would prove ineffective. Alternative therapies can be pursued immediately instead.

Breast Cancer

Just as molecular diagnostic testing of tumours determines which colon cancer patients are most likely to benefit from drug therapy using cetuximab, women with breast tumours can be screened to determine which receptors, if any, their tumour cells contain.

For example, the cells of the highly aggressive “triple-negative” breast cancer have no estrogen, progesterone, or human epidermal growth factor receptors, which are essential to the efficacy of current anti-breast cancer therapies.

The application of personalised medicine eliminates both the considerable expense and precious time of trial-and-error treatments and helps clinicians to determine quickly which breast cancer therapies are most likely to succeed.”

Alivia offers programmes for healthy clients as well as for clients with existing medical conditions and illnesses; Alivia Proactive and Ongoing Health Management, respectively.

Both programmes have been designed to incorporate the personalised approach to medicine.

For example, as part of the Alivia Proactive programme, Alivia’s medical team uses genetic tests and reviews of a client’s family medical history to prepare a report that outlines the client’s key medical risks.

These sources are critical pieces to have when looking at test results from a medical check-up/screening and trying to understand whether there any “red flags” that warrant further investigation.

Similarly for clients with existing conditions, Alivia adopts the personalised approach to understand, and suggest alternative treatment options.

This is true for all conditions but particularly in cancer cases where Alivia works with various forms of personalised oncology solutions, including molecular profiling of tumours and tumourgrafting, to assist its clients.

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