If you get past the hype and the marketing behind precision medicine, many would be surprised to learn how few genes doctors currently can use to pinpoint treatment for specific illnesses.
While the science is expanding, finding genes like BRCA1 or BRCA2 to help target certain breast cancers is still a bit like finding a needle in a haystack.
"Precision medicine is only benefiting a small number of patients," said Dr. John Marshall, chief of hematology/oncology at MedStar Georgetown University Hospital. "We need a large bandwidth to build a large enough haystack to find enough needles."
He is leading a new effort to build a new haystack after being chartered to helm the new Centers of Excellence for Precision Medicine Network for Caris Life Sciences. The Texas-based biosciences company pulled together cancer centers across the U.S., such as the Barbara Ann Karmanos Cancer Institute in Detroit, to develop standards for tumor profiling and research protocols for using it to help guide therapy decisions, and establish a collaborative forum for sharing best practices, profiling implementation strategies and case evaluations.
Georgetown's Lombardi Comprehensive Cancer Center, one of 41 National Cancer Institute-designated cancer centers, will lead the collaboration with other members to share practices on tumor profiling — the ultimate goal to prove their value, Marshall said.
"We're in this awkward adolescence," Marshall said, referring to the varying degrees to which insurers are willing to pay for tumor profiling services conducted for cancer centers by companies like Caris. "We need to prove this. Can we, in fact, improve the delivery of medicine and do it more cheaply?"
Marshall is an interesting figure to speak with in D.C.'s world of precision medicine. Alternating between frustrated clinician and enthusiastic advocate, Marshall said the implications of this emerging frontier is driving the urgency. The standard of care for a given cancer at any cancer center typically involves a trial-and-error process of testing medications to see which most effectively attacks a patient's cancer.
"If it doesn't work, we've looked at it as wasted time," Marshall said. But cancer researchers now know unsuccessful treatments don't only give cancer more time to grow, but can help different cancers evolve. "It may have driven the tumor," Marshall said. "That's the way our guidelines are written. That's how they're paid for. We give it to them and we wait and see."
Marshall knows medicine is on the cusp of helping save more of his patients, he said. But researchers have to prove it if they want reimbursement to change with it. And that's what he hopes the network will help do.
"I can keep handing out the standard of care. I get reimbursed for that. I don't get sued for that," he said. "But that's not moving the bar."
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