Tailored Treatments for Patients with Precision Medicine
Praveen Gupta
Managing Director
Premas Life Sciences

In an era where medicine is recognizing that a one-sizefits-all approach is not always appropriate, it is necessary to treat patient populations using a tailored approach.

Medicine as a field is undergoing a revolution. One of the areas that is driving this revolution is the area of precision medicine. Precision medicine is an approach to patient care that allows medical professionals to select tailor made treatments that are most likely to help patients based on their unique genetic understanding of their disease. This area of treatment development is also called personalised medicine. The idea of precision medicine is not new, but recent advances in science and technology have helped speed up the pace of this area of research.

A traditional approach to medicine is based on iterative one size fits all protocols. That means all cancer patients at the same stage and type of cancer receive the same treatment. However, different people may respond differently. After decades of research, scientists and doctors now understand that patients' tumours have genetic mutations that cause the spread and growth of tumours that are unique to individual patients. Also the same cancer-causing changes may be found in different types of cancer due to the same set of genetic mutations.

Hence most medical treatments which exist are intended for the average patient. While talking about Precision medicine it matches individual patients with the treatment that will work best suit them hence it is called personalized medicine or individualized medicine. So, precision medicine takes individual difference into account. Variations like our genes, environment, lifestyle, and even in the microscopic organisms that are living inside of us.

With precision medicine technologies including but not limited to gene sequencing, companion diagnostics, pharmacogenomics, bioinformatics, and big data analytics are expected to drive a treatment protocol that is tailor made to each patient's specific genetic mutations.

Genes and Environment Decide Our Health Status

The core of precision medicine is its efforts to understand how variations in our genes impact our health. Just as genetic variations influence our physical characteristics like height and hair color, they also contribute to our likelihood of getting specific diseases. While some genetic variations protect us from disease, and some make us more susceptible.

Genetic variations also impact how we counter to medications and other interventions. For example, it is crucial to know a person's blood type before giving them a transfusion. And by knowing individual variations in the enzymes that process drugs can help a doctor prescribe the right dose of the right medication.

Factors from the environment-including our physical surroundings, our diet, and our lifestyle-also influence our health. For instance, even if somebody inherits genetic variations that make them vulnerable to skin cancer, they can reduce their chances of getting cancer by protecting themselves from the sun. Precision medicine involves understanding how factors from the environment interact with genetic variations to influence health. When pooled with information about a person's environment, genetic information becomes even more dominant.

Genetic Testing Scenario in India

Cancer is a lethal disease that is swallowing India silently. Even those types of cancer which were once known to be rare are no longer rare. With this fatal disease on a rise, it is taking livesof many with each passing day.

As per the reports "In India, approximately 4.5 lakhs people are living with the disease, and there are more than 7 lakhs new cases being registered yearly and 5,56,400 deaths which are known to be cancer-related. Also it is estimated 71 percent of all cancer-related deaths are happening in the age group between 30 to 69 years."

In women cancer cases as well as mortality is uphill. The main reason can be attributed to low awareness and late detection. As per the data "Our country stands third after China and USA for the highest number of cancer cases among women which are growing per annum at 4.5-5%." Among men lung, oral and stomach cancers are the leading causes of death due to this noxious disease.

About one hundred different types of cancer are known in humans, and all are different from one another such as the average age at which they appear, the growth rate and the tendency to metastasize. From newborn babies to aged people, everyone is at risk of cancer.

Currently cancer treatments include a combination of surgery, chemotherapy, radiation therapy, and immunotherapy. Which treatment protocol is employed has till now depended on the type of cancer, its size, and whether it has spread. With precision medicine, information about genetic changes in your tumour can help decide which treatment will have the greatest efficacy. There are drugs that have been proven effective against cancers with specific genetic changes and are approved by the US FDA or are under development. Increasingly more of these drugs are becoming available to Indian patients and hence the need for companion diagnostics with the drug becomes more and more important.

In India we already have a cohort of genetic tests undergoing research trials which will help decide which treatments a patient's tumour is most likely to respond to, sparing the patient from receiving treatments that are not likely to help. Nodal cancer centres including Tata Memorial Hospital (TMH-ACTREC), Malabar Cancer Centre (MCC), AIIMS, PGI, TMC, CNCI along with private labs such as Strand-HCG, Med genome, GenepathDx, KDAH and many more are steering research studies on how to test whether treating patients with treatments that target the cancer-causing genetic changes in their tumours, no matter where the cancer develops in the body, will help them. These treatment protocols include a set of drugs that are known as targeted therapies.

HIV AIDS and Hepatitis C Patients Too will Benefit Tremendously from Precision Medicines

Another area of active application in India is with regards to drug resistance for cases of HIV AIDS and Hepatitis C. Over 10% of patients develop drug resistance to the initial line of therapy for these disorders and then have to move through other lines of treatments based on an iterative process. We now have active projects in India where genomics is being used to stratify drug resistant patients to customise the treatment protocol for them.

Ultimately precision medicine is driven by patient data that look at effect of these targeted therapies via clinical trials. With our current cohort of projects in the space combined with the launch of these targeted therapies in India, uptake of precision medicine in India. Just as President Obama's State of the Union address launched a national precision medicine initiative in the USA in 2015, India too needs a national level initiative. Such a national level initiative that ties in all projects plus adds more can help us redefine the treatment protocol not just for Cancer but all other complex disorders that India faces.

Future of Precision Medicine

Researchers have not yet discovered all the genetic changes that can cause cancer to develop, grow, and spread. But, slowly and gradually they are making progress and discovering new changes every day. Information from researches is being gathered in databases where researchers from across the country can access the data and utilize them in their own studies. This access and sharing of data helps move the field of precision medicine forward.

Once genetic changes are discovered, then this followed by another active area of research which entails looking for drugs that can target these changes. After that there is testing of these drugs with people in clinical trials.