There are often new buzzwords flying around that everyone uses, but few actually understand what they mean. Personalized and precision medicine are two of these terms that are often used interchangeably. Every lab wants to say they are performing personalized medicine. And to be fair we really do all provide personalized medicine in some form. Almost all lab results are used to customize the treatment for patients. However these buzzwords are used to refer to tests that describe linking genetic, lifestyle, or environmental information with predicted response to treatment. Precision medicine may be the more accurate term to describe identifying effective treatment for the right patient at the right time based on genetic, lifestyle, or environmental information. The term personalized medicine may give the false impression that therapies were developed specifically for the patient, when really they are developed to target a specific genotype or phenotype.
One example of precision medicine being used clinically today is in oncology. Many cancer drugs now require an associated test to determine the presence or absence of a specific biomarker to determine which patients are likely respond to the therapy. The biomarker tests that are linked to a specific therapy are called companion diagnostics. Biomarkers analyzed can be a specific protein or gene such as programmed death ligand-1 (PD-L1) or epidermal growth factor receptor (EGFR) or they can be much broader such as tumor mutational burden (TMB) or immune signatures. Identifying biomarkers that determine which patients are likely to respond to therapy and only giving patients with the biomarker the drug increases response rates to the therapy and may decrease side effects. More than half of the clinical trials for cancer drugs in 2018 were linked to a specific biomarker. Linking drug selection with specific laboratory tests is causing an increased need for multidisciplinary collaboration among pathology, oncology, and the laboratory.
In our lab we perform precision medicine using PCR or NGS assays to analyze patient’s tumor for specific genes. Although we still perform single gene testing when ordered, most of our cases are analyzed by a NGS panel. NGS panel testing allows us to look at numerous biomarkers with one test. This decreases the cost, time and tissue utilized to determine the patient’s biomarker status. Our NGS panel analyzes 52 genes to look for mutations that would indicate a patient is likely to respond to a targeted therapy. Most of our oncology testing is done on lung, colon, and melanoma specimens, although the panel is validated for most solid tumors. The report that we issue the oncologist provides clear information on which therapies the patient is likely to respond to or likely to be resistant to based on their tumor’s genetic profile. We also include information in the report to match patients to clinical trials. Precision medicine utilizing panel NGS testing for predicted response to treatment is becoming standard of care for many solid tumors.
-Tabetha Sundin, PhD, HCLD (ABB), MB (ASCP)CM, has over 10 years of laboratory experience in clinical molecular diagnostics including oncology, genetics, and infectious diseases. She is the Scientific Director of Molecular Diagnostics and Serology at Sentara Healthcare. Dr. Sundin holds appointments as Adjunct Associate Professor at Old Dominion University and Assistant Professor at Eastern Virginia Medical School and is involved with numerous efforts to support the molecular diagnostics field.