Precision Medicine: Better than a Coinstar Machine
Whether you’ve heard it on a television commercial for a local hospital or in a story on the nightly news, I’ll bet you are familiar with the term “precision medicine.” Yet, precision medicine is a rather nebulous concept, likely leaving many wondering what it actually means to them. Most simply, precision medicine is all about getting the right treatment to the right patient at the right time. Precision medicine has two overarching goals. The first goal is to bring a good outcome to the patient. In cancer, whether the goal is to shrink tumor size, stop metastatic progression, or even cure the patient, precision medicine promises to bring the most beneficial treatment to every patient. Just as importantly, the second goal of precision medicine is to prevent a bad outcome to the patient. By targeting a treatment to the patient most likely to benefit, patients who will not receive benefit from any given treatment will not have to endure its side effects.
But still, how does it work? How does a doctor find a treatment precisely for each patient? This is not an entirely new philosophy in medicine, cancer patients have been routinely separated by tumor site, stage, and biomarker expression to assign them to treatment regimens for decades. Yet the modern promise for precision medicine is so much more than these traditional classifications. Tumor genotyping examines the DNA of an individual’s specific tumor. Finding specific mutations in a tumor’s DNA provides an avenue to pair patients with the treatment that will benefit them the most.
Except for a few cell based therapies where a patient’s DNA is used to create a treatment specifically for that patient alone, most precision medicine therapies are are not designed for the individual patient. Instead, patients are sorted into groups and assigned to already developed therapies. The more specific the sorting, the more “precise” the medicine.
Imagine our traditional methods to treat patients are like a coin sorting machine in a bank. You dump in a bag of coins, and the machine sorts them into a few groups: pennies, nickels, dimes, quarters. If you stick a quarter in the machine, it will tell you that the value is twenty-five cents, based on the fact that most quarters are worth twenty-five cents. However, the coin sorting machine won’t be able to sort out all the quarters made before 1964, which could be worth up to $65 because they are made of 10% silver. The machine definitely won’t identify one of the 2004 Wisconsin State quarters with an extra leaf on the ear of corn which is worth up to $300! While traditional methods can separate out cancer patients into larger groups that will most likely benefit from a certain treatment, precision medicine offers the ability to pull out a small group of people who will benefit from a very specific treatment that won’t help the majority of the patients. Even better than employing someone to sort through quarters by hand with a magnifying glass, precision medicine offers the power to find these small groups of patients efficiently and effectively. Combining genomic sequencing with the work of basic scientists, clinicians, and drug development teams, precision medicine promises to help cancer patients live longer and better lives.
Jamie Holloway is a both a scientist and a survivor, earning her PhD in tumor biology from Georgetown University a few years before her own breast cancer diagnosis. Now living with no evidence of disease after treatment for early stage triple negative breast cancer, she bridges the gap between scientists and researchers as a Precision Medicine Advocate for Cure Forward and as the Patient Advocate for the Metastatic Breast Cancer Project at the Broad Institute. She works with researchers as part of the Georgetown Breast Cancer Advocates and writes about her personal experience with cancer on her blog, Run Lipstick Chemo, and as a contributor to the Cure Magazine community.