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Tailoring Treatment for Cancer

Joe Cantlupe, for HealthLeaders Media, September 13, 2012
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This article appears in the September 2012 issue of HealthLeaders magazine.

When then President Richard Nixon in 1971 called for a "cure for cancer," he envisioned a crusade akin to the efforts that developed the atomic bomb and led to the moon landing.

But more than 40 years later, it has proven to be an elusive goal, and one that has changed dramatically over the decades. Now, the vision has transformed from seeking a singular cure for cancer to finding a multitude of cures for a complex disease that differentiates into the hundreds of types. The emerging singular focus now in the so-called war on cancer is personalized medicine, which involves tailoring drugs for each patient to attack that person's individual kind of cancer. Some have dubbed it one pill for one patient, or even named it individualized medicine. Others have a different take, describing it more as precision medicine, narrowing treatment for groups with certain ailments.

To pursue and exploit innovative technology, some health systems are developing service lines or special institutes for personalized medicine, with a focus on one-patient-at-a-time cancer care. While some healthcare systems are making slow and cautious moves into the frontier of personalized medicine, others are moving quickly in a this-is-the-future-right-now environment.

Some are moving ahead because they "perceive themselves on the frontier of the movement in personalized medicine," says Edward Abrahams, president of the Personalized Medicine Coalition, an education and advocacy organization based in Washington, D.C. "Not only do we hope systemic expenses can be cut with personalized medicine, but also the possibility of adverse events by targeting cost-effective diagnoses. Researchers will use tumor and patient genomes to find new therapies and drugs for individual patients."

There are economic gaps that personalized medicine advocates believe can be bridged over time, particularly related to government reimbursements. As of now, there are technological improvements for genomic sequencing that are reducing costs significantly, according to Maurie Markman, MD, senior vice president of clinical affairs and national director of medical oncology for the Cancer Treatment Centers of America, which has five acute care hospitals and is headquartered in Schaumburg, Ill.

"The future is here," Markman says, noting that there have been gradual and significant cost reductions for genome sequencing over the past decade or so. "Within the next year, it will be possible to sequence the entire genome of a tumor and the corresponding normal genome of an individual cancer patient for $3,000. Twelve to 15 years ago, it would cost about $6 million."

CTCA has contracted for genomic research with a biopharmaceutical firm, but does not have active clinical trials linked to the partnership yet. As part of its personalized medicine focus, CTCA includes available molecular-targeted therapy approaches for breast cancer and hormone screening, according to Markman.

Terry Hisey, vice chairman and U.S. life sciences leader for Deloitte, agrees that genome cost reductions are a "major tipping point" for development of personalized medicine and, like Markman, has seen reductions in time and money. "A few years ago, it took a year and $75,000 to do the gene sequencing of a person, and now it takes a day and $1,000," Hisey says. "In terms of care capability, it's going to help the industry with the number of therapies available. Things are happening to accelerate and enable it."

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