Today the Academy of Medical Sciences launched a new report reviewing the potential of stratified medicine. ‘
Realising the potential of stratified medicine’ discusses the opportunities and challenges for stratified medicine, and makes a series of recommendations for how this approach can be used more widely in healthcare.
Stratified medicine is the technical term for an exciting development in the way we treat diseases such as cancer. It allows us to classify people into sub-groups, based on their risk of a certain disease or their likely response to a certain therapy, and to treat their condition accordingly. Personalised medicine goes one step further by tailoring treatments to a particular individual. These approaches allow doctors to exploit the specific weaknesses of a tumour, using treatments that are more effective and have fewer side-effects than traditional treatments.
We are already seeing the benefits of stratified approaches which are already in use. One of the examples mentioned in the report is vemurafenib, a drug that last year was recommended by NICE for NHS patients who have advanced malignant melanoma and a mutated BRAF gene. It was researchers here at The Institute of Cancer Research, London, who originally found that cancer progression in malignant melanoma was driven by a mutation in the BRAF gene. Vemurafenib was designed to block this cancer-causing form of the BRAF gene.
While the report does talk about some of the success stories of stratified medicine, it also highlights three areas where progress is still needed: improved collection and analysis of large-scale patient datasets; improved systems of regulation and drug pricing to incentivise the development of diagnostics and treatments; and education and training for healthcare practitioners to support the implementation.
I thought I’d take this chance to talk about the work that we are doing in this area here at The Institute of Cancer Research (ICR) to address these issues. At the ICR we are pioneering the application of stratified medicine to cancer treatment, by matching treatments to the particular molecular features of a patient’s tumour. It’s such a big focus of our work here that we have embedded this approach across our entire research programme. Our research is divided up into three themes:
1) Genetics and epidemiology
Inheritance of certain genes can predispose people to cancer, affect the way their cancer is likely to progress and help to determine how they will respond to some treatments. The ICR’s genetics and epidemiology research aims to identify these predisposition genes and understand how they interact with the environment, so that patients at high risk of cancer can be offered targeted prevention or treatment.
2)
Molecular pathology
The ICR is increasingly focused on ways of characterising the molecular make-up of different tumours and studying markers to predict response to specific therapies. In the new
Centre for Molecular Pathology which opened in November 2012, we work with our partners at The Royal Marsden to identify reliable molecular diagnostics and biomarkers, and to identify new molecular targets in different types of tumours. Our recently announced
Tumour Profiling Unit aims to analyse the molecular make-up of tumours in unprecedented detail, and to track how that make-up changes over time, so that drugs can be targeted against the specific characteristics.
3)
Therapeutics
The third strand of our approach is discovering and developing the drugs themselves. Our biologists, chemists and clinicians in the
Cancer Research UK Cancer Therapeutics Unit are using a multidisciplinary approach to discover drugs that can be developed and taken forward into clinical trials. We use ‘rational drug development’, which involves simultaneously developing new therapeutic agents and molecular biomarkers, and combining their use for personalised diagnosis and treatment. The eventual aim is fully personalised, or precision, medicine, with drugs exploiting the specific weaknesses of an individual patient’s tumour at a particular point in time.
Combining these three work streams allows us to learn more about the genetic changes that can cause cancer and how to target them with new therapies. Stratified medicine, where drugs are targeted at particular groups of patients, is already beginning to have real benefits for cancer patients. But at the ICR we believe it is just the start on the road to fully personalised treatment.
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