#EAPM: Hype v Hope - Why personalised medicine doesn’t hold all the answers…yet

A growing number of medical professionals will tell you that personalised medicine is the way of the future when it comes to diagnosing and treating patients,

The staggering advances in the genetic sciences and other areas have meant that a ‘one-size-fits-all’ model for patient care is gradually being replaced with a philosophy and work ethic that aims to to give the right treatment to the right patient at the right time.

Health-care professionals (HCPs) who are up to speed in this arena (many more are beginning to be trained in up-to-date methods) make as much use of genetic information, via Big Data, as they can. And while much more coordination, cooperation and non-silo thinking is still required, personalised medicine is helping to make significant advances in treating diseases such as cancer.

The future certainly looks brighter for the 500 million potential patients across the European Union’s 28 member states but, amid all this optimism, there is also a need for caution. Let’s take immunotherapy, for example. Recent progress in developing treatments that persuade the patient’s own immune system to attack cancer tumours has been impressive, but it is emerging that ‘immuno-oncology’ may not be as simple as some may suggest.

Unfortunately, despite the fact that a patient’s own 'T' cells can be sent into battle against molecules on malignant cells, there can still be relapses. Indeed, during an early-stage clinical trial for acute myeloid leukemia undertaken in the US, there was no improvement in survival rates.   This despite the fact that patients’ immune systems appeared to be attacking the malignant blood cells.

Tumours, in certain cases, change under attack and the target effectively disappears or sends out inhibitory signals that shut down the T cells. The tumour cells can, essentially, react in very complicated ways in their bid to counteract therapies. By adapting, these tumour cells often come up with a different way to keep growing. Not only that, but side-effects from such treatment can be severe.

Despite setbacks, however, many oncologists are certain that, down the line, immunotherapy will ultimately be made effective for many patients suffering from different cancers.   On the broader issue of side-effects, statistics show that some 50% of all patients receive a drug each year that may interact with their genes in a less-than-optimal way. However, relatively inexpensive genetic tests could eliminate these issues if the tests were widely available.   Unfortunately, to date, they are not.

But tailoring treatment and drugs to an individual’s DNA/genetic make-up is with us now - it is known as pharmacogenomics - and can relatively inexpensively help to avoid life-threatening side-effects in patients. Yet in America, for instance - home of President Obama’s Precision Medicine’s Initiative, remember -  a lack of insurance coverage for tests, plus confused and untrained HCPs unclear about interpreting genetic data, is blocking universal usage.

This is leading to needless ill effects among patients in the US, Europe and, indeed, on a global scale. It has been estimated that as many as 50 percent of hospital patients, each year, receive a drug or treatment that could be seriously harmful to them due to their individual DNA.   A recent study in the US estimated that drug-gene tests could eliminate around 400 adverse events in a patient population of 52,942. And that was only in relation to six drugs. Extrapolate from that and, by testing in relation to more medicines, the numbers rocket skywards into the hundreds of thousands in the US alone, and to many millions across the rest of the globe.

It is clear that part of the issue here, as alluded to earlier, is that the science has moved and is moving so quickly that HCPs cannot keep up and, in many cases, have little or no understanding of the possibilities offer by pharmacogenomics and other new developments.

HCPs urgently require up-to-date training in the breakthrough disciplines, such as pharmacogenomics. They need to understand what they are looking at in relation to the patient and, even before that, they need to have access to these vital and sometimes life-saving tests easily and cost-effectively.   The science is there, the future has already arrived. But without the knowledge on the front line, patients will continue to suffer needlessly from side-effects and, possibly worse, be denied effective treatment for their condition due to a lack of knowledge on the part of HCPs.

The hope of personalised medicine does, in fact, outweigh the hype. But this will only be proven once some relatively easily barriers are crossed and this ground-breaking form of treatment is made available to all.