October 30, 2009

Personalized medicine to improve outcomes

Personalized medicine to improve outcomes

Personalized medicine holds increasing promise for improving health care outcomes and preventing adverse drug events, and smack at the forefront of institutions set to usher in this new approach to care is Vanderbilt University Medical Center.

That message was delivered Monday to representatives of large local employers and health insurance companies by two of Vanderbilt's leading adherents of personalized medicine.

Dan Roden, M.D., is assistant vice chancellor for Personalized Medicine and director of the Oates Institute for Experimental Therapeutics.
William Pao, M.D., Ph.D., is assistant director of Personalized Cancer Medicine at Vanderbilt-Ingram Cancer Center. The two researchers spoke at a campus forum sponsored by the Vanderbilt Corporate Relations Program.

Dan Roden, M.D.

Dan Roden, M.D.

Common genetic variants are increasingly associated with significant differences in how patients respond to different drugs. Personalized medicine seeks to tailor drug therapy based on information about a patient's genetic make-up.

William Pao, M.D., Ph.D.

William Pao, M.D., Ph.D.

There's much at stake in the push toward personalized medicine. Roden said adverse drug events are thought to cause 100,000 deaths per year in the United States and are estimated as the fifth leading cause of death among hospital patients.

It's widely predicted that the cost for clinical lab testing to spell out an individual's complete DNA sequence will be dropping quite soon, from as much as $150,000 to around $1,000, Roden said.

In addition to cost-effective clinical testing, the major requisites for personalized medicine include research to identify more genetic predictors of drug response and technology to bring information about these predictors to bear in routine clinical decision-making. Roden said he expects several of the key elements of personalized medicine to materialize within the next five to 10 years.

BioVu is a growing Vanderbilt clinical research DNA data bank linking de-identified medical records with genetic samples from some 70,000 patients. Vanderbilt is also a powerhouse of clinical informatics development.

“It's pretty impossible to read the popular press without getting the sense that we're right on the edge of getting something big. The take-home message is that we really think all the pieces are in place here at Vanderbilt, perhaps as well as or better than anywhere else in the country, so we think that if it's going to happen, it'll happen here first,” Roden said.

On the cancer front, Pao said that in clinical trials, genotyping of lung cancer tumors is proving useful for determining which patients may benefit from traditional chemotherapy and which are more apt to benefit from newer sorts of medicines that pinpoint the genetic abnormalities that spur the growth of certain tumors.

“In the next five years we're going to have much greater understanding at the population level of what the different mutations are that make people's cancers come about and what are the targets for therapy,” Pao said.

He said Vanderbilt's Personalized Cancer Medicine Initiative is in the process of establishing automatic testing of common, clinically relevant genetic alterations in lung cancers and melanomas; establishing a high-throughput genotyping method for rarer sorts of clinically relevant genetic variants; and establishing use of information technology to automatically present oncologists at the time of clinical decision making with clinical algorithms based on the new genetic testing.

Pao said the initiative seeks to establish all three capabilities within the next several months.