Personalized Medicine

Personalized medicine is a goal of healthcare, in which treatment decisions are informed by each person's unique clinical, "OMIC" (genetic, genomic, proteomic, metabalomic) and environmental information. Because these factors are different for every person, the nature of diseases - including their onset, their course, and how they might respond to drugs or other interventions - is as individual as the people who have them. This goal
may or not be realized.

At the present time the hope is to classify people into subgroups depending on their 'omic' profile and then add in other personal factors. Although this is not 'individual' it is better than one large group with no differentiation based on molecular patterns.

Personalized medicine means making the treatment for each person, as individualized as the manifestation of the disease. It would allow accurate predictions to be made about a person's:

In order for personalized medicine to be used effectively by healthcare providers and their patients, these findings must be translated into precise diagnostic tests and targeted therapies. This has begun to happen in certain areas, such as testing patients genetically to determine their likelihood of having a serious adverse reaction to various cancer drugs.

The paradigm of personalized medicine can be illustrated as follows:

Image from the Personalized Medicine Coalition

Early Detection Testing

Early detection will continue based on large population risk. This is also referred to as screening (e.g., mammograms, colonoscopies). The hope is that new tools will enable screening to be more accurate and to find disease earlier than today's tools.

Risk Assessment: New forms of assessment will be incorporated (e.g., determining which people carry the genetic variation that increases their risk for developing cancer).

Prevention: Though true prevention must occur before disease symptoms are present, better risk assessment enables people to make life choices that may decrease their risk for developing disease.

Targeted Monitoring: (e.g., women with the genetic variation in BRCA1&2 genes should have more frequent mammograms).

Diagnosis

Today, diagnosis is clinical/symptom-driven. The new paradigm will add molecular monitoring to the equation, which may identify disease subtypes that cannot now be clinically determined. New molecular tools may also provide doctors with information on prognosis (disease outcome), which will help them make better treatment decisions with their patients.

Therapy

New molecular tools may also provide doctors with information on which drug their patients may respond to. People will fall into smaller and smaller sub-groups depending on their molecular profiles. Pharmacogenomics is also playing a role in this by finding groups of responders and non-responders to specific drugs (more about this later).

Also, the hope is that more cancers can be treated with a targeted therapy that spares healthy cells and only kills cancer cells. This may lead to a much higher quality of life due to fewer side effects, better survival outcomes and perhaps even fewer secondary illnesses caused by the initial treatment.

Response Monitoring

One goal of personalized medicine is to identify genetic variations or mutations as well as changes in gene or protein expression that can be linked to a response to a medical intervention.

The pharmaceutical industry is good at developing new drugs with the ability to kill cancer cells; but, often, when these are administered to a patient, there is an initially positive response until the cancer mutates and evolves in an effort to establish a way to overcome the effects of the therapy.

To truly wipe out cancer cells within the body, it is not enough to have effective drugs that target some of the cancer-growth pathways, it is also essential to have a way of monitoring the cancer itself, so the drug therapy can be adjusted to match the tumor as it evolves. In this way, it might be possible to use a sequence of treatments to allow a better outcome for the patient.

It's All About You

It's important to remember that personalized medicine is not solely about 'omics'.

Personalized medicine is about you, the health consumer. People vary from one another in many ways - what they eat, the life style choices they make, the types and amount of stress they experience, exposure to environmental factors, and their DNA. Many of these variations play a role in health and disease.

People also have different cultural experiences and values-these all should be included in your medical teams decision-making process.

Image provided by CISN archives. All rights reserved.

Personalized medicine also allows your health care provider, such as your physician, to focus his/her attention on what makes you "you", instead of abiding by generalities.