In medicine, particularly in the treatment of cancer, there’s no
such thing as universal. No two people are the same. Their cancers aren’t
the same. And the way they respond to therapies aren’t the same.
As co-medical director of the
UCSF – Washington Cancer Center, I’m involved in the programmatic development of the cancer program,
which includes a host of services that seek to support patients from diagnosis
and beyond, including social work, nutrition, and, potentially, palliative
care. One important aspect of this comprehensive cancer care model is
our focus on precision medicine.
As health care moves away from a traditional one-size-fits-all model,
precision medicine offers us the opportunity to create individualized treatment plans that
take into account the person as a whole. By combining genetic analysis,
medical history, lifestyle, and expectations, physicians can develop and
recommend therapies that are not only effective but increase quality of
life while treating the disease.
What precision medicine is (and isn’t)
Precision medicine isn’t just another marketing term, it’s
a medical model that uses factors like lifestyle, environment, and individual
genetic variability to choose the best therapies and prevention strategies.
Contrary to popular belief, it’s not tailored to a specific individual,
but, rather, to a subpopulation. What precision medicine is not, however,
is a silver bullet. Neither simple nor absolute, it uses all available
knowledge to predict the most effective, least detrimental treatment plan.
If it’s not a silver bullet, why use it?
Simply because of the possibility that it allows.
In the past decade, the cost of DNA sequencing has dropped significantly.
What once cost tens of thousands of dollars can now be done for just a
few hundred dollars. For institutions and academic medical colleges, it
was that cost prohibitiveness that really stood in the way of significant
genetic research. With that barrier lifted, we’re finding that just
because we have the ability to sequence DNA and identify mutations doesn’t
mean we always know what to do with that information.
Not yet, anyway.
So while, yes, precision medicine can inform personalized treatment, its
biggest contribution, at present, is in amassing a library of mutations
from which we can research, compare, and develop new treatments to target.
How it relates to the treatment of cancer
It used to be that cancers were classified and diagnosed by organ of genesis
– think lung cancer, colon cancer, or prostate cancer. This led
to a one-size-fits-all approach to treatment that yielded vastly different
responses in patients. You’d receive a diagnosis and treatment plan
that would, essentially, take you, trial and error, through treatment
options. Only once those options were exhausted would non-standard therapies
It took years of research on a genetic level to understand how and why
a type of cancer may behave a certain way. Not only does that increase
the effectiveness of therapies targeting that specific type of cancer,
we can see genetic similarities across different forms of cancers which
widens treatment options.
For instance, prostate cancer used to be thought of as hormonally driven.
It wasn’t until a few years ago that we realized that some prostate
cancer patients also had a higher instance of the BRCA-mutation. What
it means for those instances is that other therapies employed for breast
or ovarian cancers driven by BRCA mutations can also be used in prostate cancer.
This wouldn’t be possible without precision medicine.
The UCSF benefit
precision cancer medicine, UCSF has dedicated significant resources to the collection,
mapping and synthesis of data to gain a clearer picture of how diseases,
like cancer affect populations. A world leader in molecular oncology, the
UCSF 500 Cancer Gene Panel test identifies mutations within the DNA of a patient’s tumor and
matches them with targeted therapies and clinical trials. Beyond treatment,
in some cases, the UCSF 500 can offer a definitive diagnosis of the type
of cancer a patient has, or even identify genetic markers (like the BRCA
mutation) that may affect a patient’s family members in the future.
As its name implies, the UCSF – Washington Cancer Center is a partnership
between UCSF Health and Washington Hospital Healthcare System. It provides
both inpatient and outpatient care, support, and education. The goal of
this partnership is to create a comprehensive, regional healthcare network,
and provide Tri-City residents access to some of UCSF’s best specialty
services. Included is the precision medical approach to cancer diagnosis,
treatment and research – without the cost, time, and, quite frankly,
hassle associated with having to travel to San Francisco.
While precision medicine in its current form is not a cure-all –
or even a cure
most – it’s a driving force in this shift toward more intelligent,
more personalized care. By partnering with UCSF Health, Washington Hospital
Healthcare System has made a long-term investment in bringing this data-driven
future to our community. What that means in the context of cancer care
is patients and populations have better access to screenings and therapies
that ultimately lead to better outcomes.
Posted July, 2019