Dr Leonard Fromer Discusses Precision Medicine in Oncology

Cancer patients can now receive individually personalized treatment thanks to algorithms that account for their own unique factors, according to Leonard M. Fromer, MD, FAAFP, executive medical director of the Group Practice Forum.

Transcript (slightly modified)

How is personalized medicine currently being used to treat patients and in what disease states?

When we talk about personalized or precision medicine, probably the most down-the-road advanced models of what we’re doing with that, as this world changes right in front of our eyes, is oncology. It’s the ability to say that not all patients with a given kind of cancer should be treated the same way. It’s been obvious for years. Some people respond, some don’t, why is that?

If we’re giving them the same agent, and let’s talk about chemotherapy for instance, the answer is it’s their uniqueness. It’s the tumor uniqueness, it’s the staging of the tumor, it’s that own patient’s genetics and the tumor genetics of that person. It’s their other comorbidities, it’s their social environment that they’re living in. It’s all of those things put together.

So in this precision medicine initiative, what we’re first, I think, doing more than anywhere else is, looking at how do we score, if you will, how do we classify a patient with a cancer in their uniqueness. And the way that’s happening, I think, more than anything, is we are developing these nomograms, these systems of care where there’s an alphanumeric code to describe a given patient with a given cancer, and each letter or number in that code describes a uniqueness about that person. From the tumor genetics, to the patient’s own comorbidities, to the other medicines the patients might be taking, to everything that we know about staging of their tumor. All of that gets put into that code, so that we can then make better clinical decisions on how to intervene based on that person’s unique code. That’s what’s happening in cancer.

And there’s a saying in the research behind the development of that and how it’s getting better, is — we used to have research, we still obviously have research, about testing a drug for instance, research around efficacy and safety of a given agent to intervene in everything from cancer patients to heart failure patients to asthma patients to you name it. Anything. We test a drug for efficacy and safety.

The saying now that’s actually as relevant, and maybe more relevant is, we need to start testing the algorithm about how we make the decisions, not just the drug. And that’s our future. That’s precision medicine. Test the algorithm, not the drug. The decision making process. Put something together and then do research to test, does that work to get the patient better triple aim results? Very important, very big news, very different way to look at things.