The treatment of chronic disease needs a revolution.
We know that two people with the same disease can have radically different experiences. Take Lupus, for example – many patients with the condition experience a different combination of physical symptoms. Because of this, we know that a “one-size-fits-all” approach to disease treatments isn’t always effective.
The question, therefore, is: how do we make treatment more tailored to individuals and the underlying, biological causes of their disease? How do we break down a group of patients with the same disease and match them to the treatment they each require?
The answer? precision medicine.
Only coined as a term as recently as 2009, what precision medicine strives to do is understand the biology of a disease. It allows us to split a group of patients with the same disease into smaller variation groups based on biological indicators – also known as biomarkers – to determine exactly what’s driving their diseases and causing their symptoms.
An area in which this is already happening is oncology. Precision medicine is providing many cancer patients with targeted drugs, so they receive the matched treatment they each need for their type of tumor. This reduces the use of treatments which might be less effective and their potential side effects. But with chronic diseases, it’s trickier. More often than not, there’s a clear moment in which cancer is diagnosed, and then treatment begins. With a chronic disease, you could have symptoms for years, trying multiple treatments before receiving a diagnosis. The complexity of the conditions mean they can present with lots of different signs and varying underlying causes.
That said, we’re making strides. We’re actively pursuing precision medicine in the treatment of chronic diseases and we’re becoming more aware of the challenges, as well as the wide range of opportunities.
The key problem that precision medicine will enable us to overcome is the one-size-fits-all approach to the treatment of chronic diseases. By understanding the biology underpinning a disease, we can increase the probability that if you match a patient with a particular drug that targets their biology, they’ll respond to it. Not only would this make the treatment itself more effective, but it also means sparing patients the side-effects of treatments they don’t actually need. In the long term, we could reduce wasted materials and healthcare resources, too.
Advancements in technology present a huge opportunity to make this a reality. Machine learning and artificial intelligencefor instance, allows us to analyze extraordinary amounts of data, enabling researchers to look at the entire biological landscape of a patient.
To identify different subgroups of a disease, we need data to be collected from vast numbers of patients. It can be challenging to collect this data in hospital settings, for example through imaging, blood and genetic testing, and it’s also challenging to ensure it’s accessible to researchers
Where do we go next?
It’s worth acknowledging we’ve already come a long way. It’s been just over three decades since the Human Genome Project was launched to uncover what underlies and drives human health and illness at a genetic level. Since then, the industry has seen increased regulation and developed a framework for genomic and clinical data sharing while protecting patient privacy. The knowledge we’ve gained has already transformed pharmaceutical research and development, offering new hope of treatments for patients with a range of chronic diseases.
By 2015, the cost and time of per genome sequencing – a crucial part of the precision medicine approach – reduced from around $1,000,000,000 in 2006 (taking 6-8 years) to just approximately $1,000 (taking 1-3 days). And this year, the complete gap-free human genome sequence has finally been published. We’re making truly great headway.
We’ve also seen much greater availability of big data banks over the past 10 years in particular. Building on this to find better ways to gather and analyze data will be key to the advancement of precision medicine. Ensuring that these are made available to the entire community is where our focus needs to lie.
We also need data to be collected from huge numbers of patients. We need patients with chronic conditions to be made aware of and to want to participate in research trials with the support of their clinicians too.
Revolutionizing the healthcare industry with precision medicine will no doubt be a sizable challenge. But if we can collaborate – if the clinical, diagnostic, pharmaceutical and academic communities can work together – it’s achievable. We can, one day, aim to live in a world where treatments can slow, stop and even reverse chronic disease.
About the author:
Adam Platt is VP, Translational Science and Experimental Medicine at AstraZeneca.