Personalization: From Your Monogram to Your Medicine
Madi Shultz, SOCKs Communications Fellow
What is personalized medicine?
Personalized Medicine (PM) is a model that is centered on individualization of health care practices, products, and strategies to meet patient needs. The intent of the movement toward personalized care is to move toward a more patient-centered attitude that results in predictable and powerful medicine. With a growing understanding of human genetics, effective drug prescription, and safer medical treatments, personalized medicine uses collaborative work with researchers, health care providers, advocacy groups, diagnostic companies, informatics companies, biopharmaceutical companies, and, most importantly, patients to design a reliable medical treatment program.
What personalized medicine treatments are already being utilized?
Pediatric Eye Cancer:
The Children’s Hospital of Los Angeles (CHLA) has partnered with the Vision Center and Department of Pathology and Laboratory Medicine at CHLA to develop a new gene-sequencing test that will identify all medical changes related to the retinoblastoma gene in eye cancer patients. Using a patient’s human genome recorded at birth, sequencing technology, and bioinformatics, CHLA will use a “bench-to-bedside” mentality to prevent rather than react to cancerous cell formation on the eye.
BRAF is the human gene that is responsible for producing a protein called B-Raf, which helps sends signals inside cells to direct cell growth and is shown to be in mutated cells. A drug called vemurafenib, a B-Raf protein inhibitor, and the companion Mutation Test were approved for the management of late stage melanoma in 2011 working only for patients with the BRAF mutation (60% of patients).
Clopidogrel (Plavix) is an antiplatelet drug prescribed to pediatric patients with severe heart disease to prevent life-threatening blood clots from forming following cardiac procedures. However, about 20% of the global population carries a gene variation that greatly reduces the effectiveness of Plavix, at times resulting in blood clotting even while taking the medication. To combat this issue, PREDICT was created using genetic testing to locate and improve care for heart patients. Since knowledge of best care practice is known prior to the medicine being prescribed, doctors are able to tell the “poor responders” from the “positive responders” in order to prevent blood clots from forming.
What does personalized medicine look like in practice?
An example of personalized medicine in practice started at Monroe Carrell Junior Children’s Hospital at Vanderbilt in March of 2014 and has continued since then. The PM strategy is a multidisciplinary surgical epilepsy conference designed to combine areas of neuroscience, imaging, neuropsychology, and neurosurgery to coordinate patient care. Treating clinicians refer patients to the conference and present the patient’s complete epileptic history including current treatment techniques and a video of the patient’s seizure to the quorum. After presenting family, socio-demographic, and likelihood of proper care information, the quorum deliberates and personalized medical care is decided between the following:
1) neurosurgical intervention
2) alteration of drug regimens for continued medical treatment
3) continued seizure monitoring with further evaluation by the quorum in the future
Once the decision is made, the treating clinician continues personalized medical plans in the hope of reaching seizure-free status and full patient-centered success.