Precision Medicine

[Correction: An earlier version of this article misstated that Bumrungrad launched the Foundation One CDx panel. The system developed its own panel. The article is now updated. We regret the error.] Bumrungrad International Hospital, a private multiple-specialty medical centre founded 1980 in Bangkok, Thailand, announced the launch of its own genomic profiling panel for cancer treatment. A Core Genomics Facility has been established to produce validated panels in-house. Since all patients are different, specific individual treatments, often called targeted therapies or precision medicine, are customised to each patient and can be more effective than standard cancer treatments. What’s the trend Earlier in February this year, BC Platforms, a company which specialises in powerful genomic data management and analysis solutions, partnered with Bumrungrad International Hospital to provide its customisable end-to-end Software-as-a-Service (SaaS) platform to enable Bumrungrad to offer personalised healthcare solutions for their patients in the clinic. Bumrungrad will also participate in providing its extensive Asian data and samples to BCRQUEST, providing additional sample diversity and data resources for researchers. On the record “It is a misconception that cancer is mostly hereditary. In many cases, personalised cancer treatment is better. Everybody has a different genetic make-up which makes us susceptible to different diseases therefore medication can work in different ways for different people. In some cases, we can use targeted therapy to help control the cancer,” said Dr Surasit Issarachai, an Oncology Specialist at Horizon Regional Cancer Centre, Bumrungrad International Hospital in a statement.

Australia’s national science agency CSIRO and GenesisCare, one of Australia’s largest cancer care providers, today announced a A$5.1M research partnership which focuses on an emerging area of science called theranostics to develop new therapies against some of the most fatal and difficult-to-treat cancers affecting Australians. What’s it about According to the Theranostics Australia website, theranostics uses specific biological pathways in the human body, to acquire diagnostic images and also to deliver a therapeutic dose of radiation to the patient. A specific diagnostic test shows a particular molecular target on a tumour, allowing a therapy agent to specifically target that receptor on the tumour, rather than more broadly the disease and location it presents. Treatments successfully designed in the project will be trialled locally in Australia through GenesisCare's clinical network, giving Australian cancer patients access to new treatments sooner, rather than waiting for treatments to be developed and trialled overseas first. Access to this form of treatment has historically been limited globally, and it is hoped this investment may help spark a new theranostics industry in Australia to ultimately improve patient outcomes. GenesisCare is building a network of clinical centres to support research into new therapies, and is providing compassionate access to treatment for patients who have exhausted conventional treatments for prostate cancer. Currently GenesisCare offers theranostics treatment in Hurstville (New South Wales), Perth (Western Australia), on the Gold Coast (Queensland), and in Windsor (UK), with plans to introduce the treatment to more centres in 2019. The new research project forms part of CSIRO's Probing Biosystems Future Science Platform and builds on CSIRO's expertise in cancer biomarker research. What’s the trend Cancer remains the leading cause of death in Australia, with almost 50,000 deaths from cancer estimated in 2019, including 3051 deaths from pancreatic cancer, 1549 deaths from brain cancer, and 1046 deaths from ovarian cancer anticipated this year alone. On the record “We're targeting cancers that are currently the most 'untreatable', such as brain, pancreatic and ovarian cancers and metastatic cancers, because that's where we think we can make a profound difference,” CSIRO project lead Professor Stephen Rose said in a statement. “We’re exploring a very exciting approach called theranostic cancer treatment, which is a type of precision medicine that finds and attacks individual cancer cells in a person’s body – rather than attacking both cancerous and healthy cells.” Associate Professor Peter O'Brien, Chief Medical Officer at GenesisCare, said the project builds on research and ongoing clinical trials using theranostics. "We've seen a rapidly developing body of evidence in theranostics in prostate cancer and neuroendocrine tumours, and this partnership aims to accelerate the time it takes to bring findings from the lab to the clinic for other hard to treat cancers," he said. 

Bryce Olson, healthcare strategist at Intel, shares how he kicked cancer thanks to precision medicine and his work to empower cancer patients.

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Pinnacle Ventures has launched a pharmacogenomics programme to enable genetic testing to drive personalised prescribing decisions. The innovation arm of Pinnacle Midlands Health Network, a not-for-profit primary health care management company in New Zealand, is also working on embedding biomarker information into electronic health records and linking it to a clinical-decision support prescribing tool that can help prescribers by providing direct access to international pathways and guidelines. Pharmacogenetics involves prescriptions being tailored to a person’s genetic make-up, as people metabolise drugs in different ways, which can have a significant impact on a drug’s effectiveness. Ventures plans to do about 5,000 pharmacogenetic tests over the next 12 months, says chief executive John Macaskill-Smith. Some will be self-funded because individuals are struggling with their medications and others will be fully funded by Ventures, targeting specific groups within the Midlands population. Macaskill-Smith says it is a simple test that covers 65–70 per cent of medications frequently prescribed in New Zealand. “The New Zealand health system is under strain but using testing like this you could reduce the trial and error of prescribing and prevent adverse reactions to medications,” he said. Ethnicity plays a big part in how a person metabolises drugs, but the clinical trials that prescribing information are based on very rarely involve Māori or Pasifika test subjects. Macaskill-Smith said Ventures is partnering with key kiwi groups, Auckland University and Otago University medical schools and Callaghan Innovation to support research and develop a better understanding of how unique New Zealand populations respond to different medications. People who have a pharmacogenetic test can choose to consent to contributing their non-identifiable demographic information to researchers. Embedding the biomarker information into EHRs ensures a patient’s results are used for both current and future prescribing decisions, he said. Macaskill-Smith says a lot of direct-to-consumer online genetic-testing tools involve people essentially “giving away their DNA” as there are no protections or consent processes for how the testing company might use it. “You can lose ownership and visibility of where your DNA has gone. We are saying your DNA is yours and you should have control over it, so we are trying to promote safe and informed use of your genetic information by embedding it back into your own EHR,” he said. “Seeing an individual’s health record shift away from being largely about providers recording notes around their activity to actually becoming a blueprint for an individual’s health and wellness information is incredibly exciting. “This is the real health revolution that is about to occur, and including and using your DNA is core to this.” A virtual training package to help primary care providers respond to this genetic information is also being offered. The US Food and Drug Administration requires pharmaceutical companies to publish biomarker information in relation to how people with different genetic make-ups might respond to specific medications. Many health providers in the US use pharmacogenomics as a key tool in treating their patients, and other places, such as Canada and the European Union, are heading in this direction. The New Zealand government does not require this information to be published, but international curators have emerged and can be used to access individual drug information and treatment pathways to inform how doses should be altered according to people’s genetic make-up. This article first appeared on eHealthNews.nz.

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Earlier this week, the Western Australia (WA) Government announced the establishment of a new Ministerial Council that will advise the State Government on opportunities to further develop and support precision health advances. Precision health uses new and emerging technologies to enhance disease prevention and early detection, and improve patient outcomes through treatments tailored to patients' individual genetic profiles, as well as their variable responses to the environment and lifestyle.  The Precision Health Council will be chaired by South Metropolitan MLC Kate Doust and is expected to hold its first meeting within the coming months. According to the official statement, the council will comprise stakeholder representatives from medicine, science, industry, Aboriginal health, patient organisations, medical research and commercialisation, as well as experts from key precision health-related technologies of genomics, phenomics, informatics and geographical information systems. Early priorities of the council will include identifying and enhancing successful precision health initiatives already operating in WA's health system, and determining key areas that could benefit from increased integration of precision health measures. On the record “Western Australia already benefits from emerging precision health initiatives such as the Undiagnosed Diseases Program of WA (which provides earlier diagnosis for people with rare and baffling medical conditions), and the Australian Genomics Cancer Medicine Program (which harnesses precision genomics technology to match patients with rare and untreatable cancers to tailored clinical trials).” “I look forward to being advised by the new council about potential advances in this exciting field,” said Health Minister Roger Cook in a statement.

Successful healthcare transformation depends on merging compliance with convenience in tools used by clinicians, says Elena Bonfiglioli, Microsoft's Managing Director of Health and Life Sciences for Europe, Middle East and Africa.

The project was showcased in the latest issue of the HIMSS Insights eBook, published at the beginning of April.

The teams will collect, process and analyze EHR data of up to 3,000 patients to create personalized care plans for people with MS.