In his State of the Union Address earlier this year, President Barack Obama announced a multi-million-dollar “Precision Medicine Initiative” and spoke of a future in which patients would get “the right treatments at the right time, every time.”
At UC San Diego Health, the future has already arrived.
But what, exactly, is precision medicine? Despite its name, there is no precise definition of precision medicine (or the earlier, synonymous term “personalized medicine”). Generally speaking, however, it means that doctors tailor medical treatment to the individual characteristics of each patient. These characteristics range from very broad to infinitesimally small, from gender (men and women differ in their susceptibility to different diseases, for example) to gene mutations on a single chromosome. The idea is to devise a treatment – or combination of treatments – that has the best chance of success for that one, singular patient.
Cancer is famously described as the “Emperor of All Maladies.” In fact, it is a disease of many kings and many things. “Just as no two people are alike, no two cancers are the same,” said Razelle Kurzrock, MD, senior deputy director of clinical science at UC San Diego Moores Cancer Center.
That makes cancer a perfect target – or rather, targets – for precision medicine – and Kurzrock and colleagues are taking aim. Kurzrock is director of the Center for Personalized Cancer Therapy at Moores Cancer Center, where patients can already experience the fruits of precision medicine.
Specifically, a Moores Cancer Center oncologist can order molecular testing of a tumor’s genetic profile, with the results forward to the weekly Molecular Tumor Board. This is a group of doctors of multiple specialties, basic scientists, geneticists, bioinformaticists and experts from the San Diego Supercomputer Center who discuss patients with difficult cancers and how best to formulate the singular treatment most suitable for each of them.
“No two patients have the same portfolio of molecular/biologic abnormalities,” said Kurzrock. “Patients have metastatic tumors that are like ‘malignant snowflakes.’ Not only do they need drugs that target their tumor abnormalities with precision, each patient also needs therapies that are personalized for their particular tumor.”
While current molecular testing focuses upon the most difficult cases where there are no easy or obvious remedies, doctors and scientists at Moores Cancer Center hope to eventually make genetic testing a routine part of every consenting patient’s visit.
Last year, UC San Diego and La Jolla-based Human Longevity, Inc. (HLI) began a collaborative effort to sequence the genome of every consenting Moores Cancer Center patient.
HLI was co-founded by J. Craig Venter, PhD, a UC San Diego alumnus who is perhaps best known for his central role in sequencing the human genome. Venter and Francis Collins, the current director of the National Institutes of Health, are generally credited as being the primary drivers of that effort, with Collins heading a publicly funded program while Venter oversaw a company focused on the same effort.
Cancer is the initial focus of the UC San Diego-HLI collaboration, but ultimately HLI hopes to sequence tens of thousands of human genomes annually, using the data to investigate and develop treatments for a wide array of diseases, from diabetes and obesity to conditions of the heart and liver, plus ailments related to aging and biological decline.
“This is ground-breaking research,” said Scott Lippman, MD, director of Moores Cancer Center and the program’s principal investigator. “The therapeutic promise of genomics is far-reaching. Gathering the genomic data is the first step of the research process. Cancer is a target-rich environment and the current pace at which genomics discoveries are moving from the lab to the clinic is unprecedented. Being able to sequence at this scale, with this depth of detail and complexity, will accelerate discovery and make it easier to translate these findings to benefit our patients.”
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