The science is getting sharper and the barriers to reimbursement are eroding. But another major obstacle remains to delivering on the promise of precision medicine.
It involves getting the right information into the hands of front-line doctors in a way that they can use it, experts and entrepreneurs in the field said in a series of interviews with MedCity News.
“The critical information has to be on one page. The clinician has to be able to interpret it in one minute,” said Daniel Rhodes, co-founder and CEO of Strata Oncology, a genomic testing and data company based in Ann Arbor, Michigan. “If we can do that, we can expand the use of the most compelling therapies and trials that are available.”
Precision medicine relies on collecting genetic and genomic information from patients and using the results to target therapies, be it in oncology or in rare and difficult-to-treat diseases. The information can also determine whether a given medication will work for more common ailments. However, genetic-test results and treatment guidance often arrive in a lengthy format that can take time to decipher.
Not surprisingly, roughly two-thirds of Americans still have not heard of precision or personalized medicine, according to a fall survey by the Personalized Medicine Coalition, based in Washington, D.C. Only 11 percent of patients say their doctors have discussed or recommended personalized treatment options, the coalition added.
“Perhaps the greatest challenge to integrating personalized medicine into health care is a lack of education and awareness among patients and health care professionals,” the coalition wrote in a November report.
The need for clearer information propelled the launch of 2bPrecise. The Raleigh, North Carolina-based company has developed a platform to bring genetic and other data to the point of care to help create more tailored plans for patients. The platform, for example, could determine whether a patient might benefit from a current clinical trial or help doctors understand a patient’s response to certain medications.
Dr. Joel Diamond, the company’s chief medical officer and a co-founder, said critical information often is buried in dense, lengthy documents. An “aha moment” came when he and the company’s CEO, Assaf Halevy, were listening to someone talk about how advances in cancer genetics would change cancer care. The speaker was showing a 30-page PDF packed with technical language.
“One nugget was important to the oncologist to treating a patient,” said Diamond, who still cares for patients at a family practice in Pittsburgh. “But it was one nugget in this 30-page PDF.”
Another challenge for community oncologists is the rapid pace of change in precision medicine, said Priti Hegde, chief scientific officer at Foundation Medicine, a cancer diagnostics company based in Cambridge, Massachusetts, now part of Roche.
Foundation Medicine and other companies are quickly developing liquid biopsies and other tests that can match a specific therapy based on the genetic make-up of a patient’s tumor. Originally targeting advanced cancers, the therapies themselves are moving into earlier and earlier lines of treatment.
“I think the more complex the treatment landscape becomes, the more we need to simplify the decision landscape for oncologists,” Hegde said,
Foundation Medicine has been taking steps in that direction. In 2015, for example, the company launched a molecular tumor board program to help practicing oncologists understand the company’s reports and their clinical utility. At the same time, the forums help the company learn what oncologists need, Hegde said.
“Understanding what keeps oncologists from leveraging precision diagnostic tools is really helping us figure out how to help them,” she added.
Educating doctors also is a focus for Color, a health technology company whose services include genetic testing. About half the calls to its genetics counselors come from physicians, said Alicia Zhou, chief science officer at Color, which is based in Burlingame, California.
Some doctors, already well-informed on genetics, are calling to probe the technical underpinnings of a report, Zhou said in a phone interview. Others may be more in need of a primer, particularly if they went to medical school before genetics was a common area of study.
“We want to make sure your primary care provider knows what to do with our results,” Zhou said.
The widespread use of genetic and genomic data in health care is inevitable, Zhou said. “The question is when is that future. Is it 50 years from now? Is it 10 years? Is it five? The difference between making it 50 years from now versus five years is making sure the medical community can use the data without feeling like it is a giant unknown.”