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A whole range of new treatments and technologies, generally called precision medicine or personalized medicine, promises a future in which treatment options for a wide range of diseases and conditions will be specifically targeted to your genome and current health condition.
That means the future of healthcare may be all about you. The individual you. Medical treatments will begin to look beyond categories such as age, weight, height, overall health, and history of medical conditions and take into account your unique genetic makeup as well.
That future is being made possible by advances in high-powered computing, data analytics, machine learning, and artificial intelligence. And increasingly, these advances are not off in the future but already here. Remarkable customized treatments are already available, and more of them are being used every day.
Here's a look at the current state of precision medicine, how computing technology has made it possible, and what it might look like in the future.
The push for precision medicine started in earnest in 2003, when the Human Genome Project successfully mapped the human genome: the precise genetic sequences that make up all of our genes. The hope was, with that done, researchers could identify genes that cause disease, target individuals with those genes, and then customize treatments for them. Accomplishing that has taken longer than initially envisioned, in part because of the complexity of the relationship of genes to disease. But it has gained a big boost in recent years because of gains in computing technology.
“Thanks to recent advances in computing technology, we’re seeing doctors and drug companies being able to more precisely target treatments to specific patient populations,” says Kevin Julian, Accenture senior managing director, Life Sciences and Accelerated R&D Services, North America. “The cloud has been particularly important in this, because the cloud makes it easier to connect to vast amounts of patient data and bring it into the drug research and development process.”
It’s not just the cloud that makes this possible, Julian adds. So do powerful computers that can perform faster data analytics and handle larger amounts of data. In the future, he expects machine learning and artificial intelligence to play an increasing role as well.
Julian notes that it’s not just raw computing power to analyze data that will make precision medicine more commonplace. It’s that computing power is dramatically bringing down the cost of research to discover the new drugs and techniques that make precision medicine possible.
“It’s a business equation,” Julian says. “If it takes $2.6 billion to develop a drug, a pharmaceutical company needs to get a return on that $2.6 billion investment, which means the drug has to help a large number of people. But if technology can bring that $2.6 billion down to a couple of hundred million dollars, you can develop drugs for a much smaller and highly targeted number of people and still make a profit.”
If there’s an equivalent to the Human Genome Project for precision medicine, it’s the National Institutes of Health (NIH) All of Us project, which aims to gather the genetic information and other health data of more than 1 million people. The information will be made available to researchers and medical professionals so they can craft new personalized treatments. All of Us is part of the NIH Precision Medicine Initiative (PMI), whose goal, according to the NIH, is to “enable a new era of medicine in which researchers, healthcare providers, and patients work together to develop individualized care.” PMI was launched in 2016 with $130 million in federal funding for the All of Us project, and an additional $70 million for the National Cancer Institute to research cancer genomics.
If there’s any doubt that technology is at the forefront of the movement toward precision medicine, consider who was chosen to lead All of Us: not a biomedical researcher or doctor, but Eric Dishman, a technologist. Before taking the helm at All of Us, Dishman was head of Intel’s healthcare strategy and research, where he oversaw, among other things, the creation of open source tools and open platforms for health researchers, including big data platforms for cancer genomics.
Dishman will need all of that experience to make All of Us a success, because at its heart, it’s a massive data gathering, storage, and distribution operation. That starts with outreach to people who are willing to volunteer their information, then putting together a big data platform for storing, managing, and sharing it.
Dishman says he was hired precisely because of his technology background. He believes he was offered the job because he told NIH director Francis Collins, “You know you’re building a technology platform, don’t you?”
Dishman has a personal reason for overseeing the project: He is alive today in large part because of an early use of precision medicine. At the age of 19, he was diagnosed with a rare form of liver cancer, and precision medicine—including finding out his tumor’s precise molecular makeup and understanding the DNA mutations that caused the cancer—helped cure it.
As Dishman’s medical history shows, precision medicine isn’t a pie-in-the-sky future technology. It’s already here. The Personalized Medicine Coalition, which includes technology companies, scientists, patients, healthcare providers, pharmaceutical companies, insurance companies, and others, covers much of the state of the art in its 2017 Personalized Medicine Report. The report notes that the number of personalized medicines has increased from five in 2008 to 132 in 2016. It adds that 42 percent of all drugs currently in development are personalized medicines, including 73 percent of all cancer drugs. The report also says that, according to biopharmaceutical researchers, there will be a 69 percent increase in the number of personalized medicines in development over the next five years.
Cancer is one of the prime targets of precision medicine, notes Lisa Wright, HPC program manager, Life Science Vertical Solutions, at Hewlett Packard Enterprises. She says, for example, years ago breast cancers were usually treated by performing a mastectomy, which was followed by radiation therapy and chemotherapy. Women had to live with the side effects of the treatment for the rest of their lives.
Today, though, doctors can take a biopsy of a breast cancer and sequence its DNA. Based on the results, the doctors can identify the type of cancer and craft a way to treat it. If the cancer is fed by estrogen, for example, doctors can remove the tumor and then prescribe a drug to remove estrogen from the body, reducing the risks of the cancer recurring.
It’s not just breast cancer that can be treated with precision medicine. Other types can, too. “I’ve heard stories where someone is being treated for leukemia and the standard medications aren’t working,” Wright says. “When the doctors sequenced the genome, they found out the cells look like a different kind of cancer that responds to different drugs. So they prescribed a different drug and the person survived. In that way, precision medicine is like peeling back the layers of an onion, looking at genetic makeups and identifying a precise treatment for you.”
Precision medicine for treating cancer has taken steps beyond even that, including genetically engineering a person’s immune system to kill cancer. Kite Pharma’s drug Yescarta has been approved by the U.S. Food and Drug Administration to treat aggressive forms of non-Hodgkin’s lymphoma, a blood cancer. With the treatment, millions of a person’s T cells, a vital part of the immune system, are frozen and sent to Kite Pharma, where they are genetically engineered, using a person’s unique genetic makeup, to kill the cancer cells. The engineered cells are frozen and sent back to the hospital, where they are delivered back into the patient via IV. Dr. Caron A. Jacobson, who participated in a study of the treatment at the Dana-Farber/Brigham and Women’s Cancer Center in Boston, told The New York Times, “You’re really seeing people get their life back. After a couple weeks in the hospital and a couple weeks at home, they go back to work. On its face, it’s quite remarkable and revolutionary.”
Yescarta was the second drug approved by the FDA to use precision medicine in this way. The first, Kymriah, made by Novartis, is used to treat children and young adults with an aggressive type of acute leukemia.
All this is possible because of how much more quickly and cheaply a person’s genome can be mapped today. It took more than a decade and $3 billion for the Human Genome Project to sequence the human genome. Today, thanks to high-powered computing and other techniques, a person’s genome can be mapped in a few hours for $1,000.
Wright expects that the ability to quickly and relatively inexpensively sequence the genomes of individuals will lead to more treatments using precision medicine than just for cancer.
“In the future, maybe you’d go into a doctor’s office and they’d sequence your genome in an hour, and the doctors would basically have a blueprint of your body and the way it works,” she says. “Doctors might be able to use it for all kinds of things. For example, if you have a problem with weight, they might be able to look at your genome and say, ‘Your body can’t handle this kind of carbohydrate, so you need to change your diet.’ And that’s just the start. It could revolutionize the way medicine works.”
This article/content was written by the individual writer identified and does not necessarily reflect the view of Hewlett Packard Enterprise Company.