As a practicing oncologist with several years of experience, I am excited and amazed by the rapid advances we are making in precision medicine. Since the FDA approved imatinib (Gleevec) for the treatment of chronic myeloid leukemia in 2001, targeted treatments for patients with specific genetic mutations along with advances in immunotherapy have been the most significant developments in cancer treatment.
However, the advances in technology, genomic analysis, and precision medicine treatments are outpacing current medical education, clinical services, and clinical research programs.
One of the barriers to precision medicine stems from the fact that many physicians did not receive training on how to determine the best course of treatment based on genomic testing results since these diagnostic methods simply did not exist when they were in medical school. Furthermore, understanding test results is a complex process that often involves discussions with the genomic testing company as well as molecular tumor boards.
Currently, medical schools across the country are beginning to incorporate precision medicine into their curriculum, but there is much room for improvement as there are still numerous academic institutions that do not provide such a focus. Furthermore, in the last 2 to 5 years, only a handful of schools have started funding research and centers in precision medicine.
Since the future of healthcare, and not only cancer care, will involve precision medicine and genomics, I believe every medical school should add precision medicine to its curriculum. It is also imperative that current physicians are able to provide medical care involving the latest diagnostic and treatment approaches, and I, therefore, believe that every practicing oncologist should prioritize precision medicine in their continuing medical education (CME) courses.
Although medical education is needed, it is not the only area that requires investment. Patient care and clinical services are two other areas where there is much catching up to be done. There are specialists — including molecular and clinical geneticists, and genetic counselors — who interpret genetic test results. However, their numbers are not enough to meet current and future healthcare needs. In addition, incorporating precision medicine into patient treatment plans requires greater support, governance, investment, and new infrastructure. For example, only credible labs and tests and a strong data-capturing structure can ensure that patients are offered the best treatments, as well as ensure outcomes are tracked for use in future potential patients.
Other than a handful of academic medical centers and dedicated cancer centers, the infrastructure does not exist, which limits patient access. Medical centers, therefore, need to improve their current infrastructure and increase access to genomic testing by incorporating molecular tumor boards and supportive databases, as well as educating clinical staff on how to develop these programs. A strong precision medicine program can lead to better treatment options for patients, improve understanding of genetic mutations and therapies, and help advance clinical trials and drug development, so progress is in everyone’s best interest.
Lastly, efforts should be made to expand the inclusion criteria so elderly patients can enroll in precision medicine clinical trials. There are many trial tests approved and investigational treatments, but the inclusion and exclusion criteria for most studies are so restrictive that elderly patients rarely qualify for enrollment. In most cases, either their cancer is too advanced or they are too sick, and thus, underrepresented in studies — even though they are the patients most in need of effective treatment. The real-world experience and future promise of precision medicine necessitates new thinking and improvements in our clinical research programs.
While advances in precision medicine are exciting, it is not yet part of routine care for most patients. To take full advantage of all that precision medicine can offer, we must invest in medical education, clinical services, and clinical research to ensure patients have greater and equal access to treatments regardless of age, location, the physician treating them, or the hospital admitting them.
Ankur R. Parikh, DO, is the Medical Director of Precision Medicine at Cancer Treatment Centers of America (CTCA). Prior to joining CTCA, Parikh completed a fellowship in hematology-oncology at the National Heart, Lung, and Blood institute of the National Institutes of Health.