Tomorrow's cancer care, experts say, will increasingly rely on targeted
prevention and treatment plans that use mapping of the genome to apply
what works best for a person’s genetic makeup. And tomorrow’s
You’ve probably read about precision medicine. “It’s
the future of cancer care,” says
Michael Scoppetuolo, M.D., Saint Barnabas Cancer Center’s chief medical officer.
Genome sequencing breakthroughs at the turn of the 21st century, the U.S.
Food and Drug Administration explains, helped turn precision medicine
from a concept into a reality. “Rapid developments in genomics,
together with advances in a number of other areas, such as computational
biology, medical imaging and regenerative medicine, are creating the possibility
for scientists to develop tools to truly personalize diagnosis and treatment,”
according to the FDA’s website.
Dr. Scoppetuolo is the first to admit that this “game changer”
is “just in its infancy right now.” About two dozen FDA-approved
drugs are designed to work in this way, he says, and lung cancer treatments
have led the way.
(See “Lung Cancer: Good News For Patients,”) “Much of the early research came from the lung cancer experience,” he says.
But treatment of other cancers is benefiting too. For instance, a gene
that plays a part in about 20 percent of breast cancer cases can now be
targeted with a medication that inhibits its action. “It blocks
the receptor on the surface of the cancer cell that is expressed by this
gene, and that kills the cancer,” says the doctor. Other new drugs
treat leukemia, colon cancer and melanoma.
A recent report from a group called the Personalized Medicine Coalition
shows that for the past three years, precision medicines accounted for
more than 20 percent of the new molecular entities approved by the FDA.
And a lot more drugs are in the pipeline. “There are hundreds more
currently in trial,” says Dr. Scoppetuolo. Some of those trials
are being conducted at Saint Barnabas, including a joint trial with the
Rutgers Cancer Institute of New Jersey.
Currently, precision medicine is approved as a treatment option only after
other avenues have been shown to be ineffective. The main reason is the
medications’ high cost. “The average cost is about $10,000
a month,” Dr. Scoppetuolo says. Often insurers won’t pay for
these drugs, and when they do there may be a copay that puts them out
of reach for many patients. At Saint Barnabas, counselors work with the
insurance companies to find ways to lower these costs. Another option
is to enter a trial, which is paid for by the drug’s manufacturer.
Over time, as new medications continue to come to market and are proven
effective, insurers will become more amenable to coverage, the doctor
predicts. Prices will come down, and a 2013 article in The Hugo Journal,
an official publication of the Human Genome Organization, argued that
precision medicine will “lower overall healthcare costs.”
How? By steering away from blind alleys, helping “to identify the
right drug for the right patient at the right time, avoiding the prescription
of costly and ineffective drugs and preventing potentially harmful side
Before long, precision medicines are expected to move from last-ditch options
to so-called first-line treatments. Already, patients who have few good
chemotherapy choices can be tested for gene mutations for which current
drugs may block a gene’s expression. Someday soon, says Dr. Scoppetuolo,
a drug may be used before the cancer ever surfaces.
The approved precision medicine drugs have come on the scene in the last
five years. The next five may just bring a small revolution. Says the
doctor: “I really feel that precision medicine will supplant chemotherapy
as we now know it.”
A report from the Personalized Medicine Coalition (PMC) says precision
medicine can make patients healthier while lowering health care costs.
It documents a 62 percent increase since 2012 in the number of precision
medicines on the market and reports benefits that include:
- Shifting the emphasis in medicine from reaction to prevention.
- Directing targeted therapy and reducing trial-and-error prescribing.
- Reducing adverse drug reactions.
- Revealing additional targeted uses for medicines and drug candidates.
- Increasing patient adherence to treatment.
- Reducing high-risk invasive testing procedures.
- Helping control the overall cost of health care.
The report also states that unclear regulatory guidelines and ongoing challenges
related to reimbursement and clinical adoption continue to make it difficult
for health care systems around the world to reap the benefits of precision
medicine. Still, “precision medicine offers an unprecedented opportunity
to deliver medical care that is more efficient and effective,” says
PMC President Edward Abrahams, Ph.D.
To learn more about the Cancer Center or speak with our nurse navigator,
please call 973.322.2929 or visit our
Cancer Program's Website.