Precision medicine

Precision medicine (PM) is a medical model that proposes the customization of healthcare, with medical decisions, practices, and/or products being tailored to the individual patient. In this model, diagnostic testing is often employed for selecting appropriate and optimal therapies based on the context of a patient’s genetic content[1] or other molecular or cellular analysis. Tools employed in PM can include molecular diagnostics, imaging, and analytics/software.[2]

Relationship to personalized medicine

In explaining the distinction from a similar common term of personalized medicine, the National Research Council explains:

Precision Medicine refers to the tailoring of medical treatment to the individual characteristics of each patient. It does not literally mean the creation of drugs or medical devices that are unique to a patient, but rather the ability to classify individuals into subpopulations that differ in their susceptibility to a particular disease, in the biology and/or prognosis of those diseases they may develop, or in their response to a specific treatment. Preventive or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side effects for those who will not. Although the term ‘Personalized Medicine’ is also used to convey this meaning, that term is sometimes misinterpreted as implying that unique treatments can be designed for each individual.[2]

On the other hand, use of the term "precision medicine" as well can extend beyond treatment selection to also cover creating unique medical products for particular individuals—for example, "...patient-specific tissue or organs to tailor treatments for different people."[3] Hence, the term in practice has so much overlap with "personalized medicine" that they are often used interchangeably.[4]

Scientific bases

Often, though not necessarily, PM involves the application of panomic analysis and systems biology to analyze the cause of an individual patient's disease at the molecular level and then to utilize targeted treatments (possibly in combination) to address that individual patient's disease process. The patient's response is then tracked as closely as possible, often using surrogate measures such as tumor load (v. true outcomes, such as 5 year survival rate), and the treatment finely adapted to the patient's response.[5] The branch of precision medicine that addresses cancer is referred to as "precision oncology".[6][7]

Inter-personal difference of molecular pathology is diverse, so as inter-personal difference in the exposome, which influence disease processes through the interactome within the tissue microenvironment, differentially from person to person. As the theoretical basis of precision medicine, the "unique disease principle"[8] emerged to embrace the ubiquitous phenomenon of heterogeneity of disease etiology and pathogenesis. The unique disease principle was first described in neoplastic diseases as the unique tumor principle.[9] As the exposome is a common concept of epidemiology, precision medicine is intertwined with molecular pathological epidemiology (MPE). MPE research is capable of identifying potential biomarkers for precision medicine.[10]

Practice

The ability to provide precision medicine to patients in routine clinical settings depends on the availability of molecular profiling tests, e.g. individual germline DNA sequencing. Many different aspects of precision medicine are tested in research settings (e.g., proteome, microbiome), but in routine practice not all available inputs are used. The ability to practice precision medicine is also dependent on the knowledge bases available to assist clinicians in taking action based on test results.[11][12]

On the treatment side, PM can involve the use of customized medical products such drug cocktails produced by pharmacy compounding[13] or customized devices.[14] It can also prevent harmful drug interactions, increase overall efficiency when prescribing medications, and reduce costs associated with healthcare.[15]

In his 2015 State of the Union address, U.S. President Barack Obama stated his intention to fund a United States national "precision medicine initiative".[16] A short-term goal of the Precision Medicine Initiative is to expand cancer genomics to develop better prevention and treatment methods.[17] In the long-term, the Precision Medicine Initiative aims to build a comprehensive scientific knowledge base by creating a national network of scientists and embarking on a national cohort study of one million Americans to expand our understanding of health and disease.[18] The Mission Statement of the Precision Medicine Initiative reads: "To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized treatments".[19]

See also

References

  1. ↑ Lu, Y.-F.; Goldstein, D. B.; Angrist, M.; Cavalleri, G. (24 July 2014). "Personalized Medicine and Human Genetic Diversity". Cold Spring Harbor Perspectives in Medicine 4 (9): a008581–a008581. doi:10.1101/cshperspect.a008581. PMID 25059740.
  2. 1 2 Timmerman, Luke (4 February 2013). "What’s in a Name? A Lot, When It Comes to ‘Precision Medicine’". Xconomy.
  3. ↑ LAT Brand Publishing (23 February 2015). "Changing medicine with 3-D bioprinting, where organs can be synthesized by technology". latimes.com.
  4. ↑ "N-of-One: Tailored Clinical Molecular Test Interpretation". n-of-one.com.
  5. ↑ Blau, CA, Liakopoulou, E (2013). "Can we deconstruct cancer, one patient at a time?". Trends in Genetics 29 (1): 6–10. doi:10.1016/j.tig.2012.09.004.
  6. ↑ Levi A. Garraway, Jaap Verweij and Karla V. Ballman (2013). "Precision Oncology: An Overview". J. Clinical Oncology 31 (15): 1803–1805. doi:10.1200/jco.2013.49.4799.
  7. ↑ Jeff Shrager, Marty Tenenbaum (2014). "Rapid learning for precision oncology". Nat Rev Clin Oncol 11 (2): 109–118. doi:10.1038/nrclinonc.2013.244.
  8. ↑ Ogino S, Lochhead P, Chan AT, Nishihara R, Cho E, Wolpin BM, Meyerhardt AJ, Meissner A, Schernhammer ES, Fuchs CS, Giovannucci E. Molecular pathological epidemiology of epigenetics: emerging integrative science to analyze environment, host, and disease. Mod Pathol 2013;26:465-484.
  9. ↑ Ogino S, Fuchs CS, Giovannucci E. How many molecular subtypes? Implications of the unique tumor principle in personalized medicine. Expert Rev Mol Diagn 2012; 12: 621-628.
  10. ↑ Ogino S, Lochhead P, Giovannucci E, Meyerhardt JA, Fuchs CS, Chan AT. Discovery of colorectal cancer PIK3CA mutation as potential predictive biomarker: power and promise of molecular pathological epidemiology. Oncogene advance online publication 24 June 2013; doi:10.1038/onc.2013.244
  11. ↑ Huser, V; Sincan, M; Cimino, J. J. (2014). "Developing genomic knowledge bases and databases to support clinical management: Current perspectives". Pharmacogenomics and Personalized Medicine 7: 275–83. doi:10.2147/PGPM.S49904. PMC 4175027. PMID 25276091.
  12. ↑ Ashley, E. A. (2015). "The precision medicine initiative: A new national effort". JAMA 313 (21): 2119–20. doi:10.1001/jama.2015.3595. PMID 25928209.
  13. ↑ "Divining your future in healthcare". pmlive.com.
  14. ↑ "3D-Printed Medical Devices Spark FDA Evaluation". LiveScience.com.
  15. ↑ "Personalized Medicine Benefits - The Jackson Laboratory". jax.org.
  16. ↑ Neergard, Lauran (30 January 2015). "Obama Proposes 'Precision Medicine' to End One-Size-Fits-All". Drug Discovery & Development. Associated Press.
  17. ↑ "Near-term Goals". nih.gov.
  18. ↑ "Longer-term Goals". nih.gov.
  19. ↑ "The White House Precision Medicine Initiative".
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