Cancer is always personal, but since a close colleague’s mother died of triple negative breast cancer – a particularly rare and vicious disease – it has taken on a particular resonance for me and my team. It means when we talk about personalised medicine as being the future of cancer care, it has real meaning.
Personalised medicine, or care, sounds like a buzzword – and it has certainly been touted as a panacea of future healthcare. Broadly speaking, it is a growing area of treatment that offers bespoke medical care on an individualised basis; allowing researchers to break down each person’s genomic makeup in order to interpret genomic information and target genes that have mutated, which is particularly useful in many disease areas including oncology.
As World Cancer Day is upon us once more, now is a good time to reflect on what personalised medicine means for cancer patients, today and in the future. It is impossible not to be passionate about working towards the breakthroughs that personalised medicine could offer when you hear the power of patient stories. It makes you more determined to help put the right conditions in place for personalised medicine to flourish. For me, partnership and collaboration across the system – from research scientists to clinicians to pathologists – holds the key to this.
In the last 20 years, research and development in this area has led to significant benefits being realised for patients. Personalised medicine is bringing researchers closer to making cancer a chronic disease that can be managed, like asthma or epilepsy, instead of a life-threatening disease. As the definition of cancer changes – it is now considered a group of diseases – personalised medicine has become even more relevant as it allows us to target treatment.
Genomics and personalised medicine are inextricably linked. But while genomics is a key element of personalised medicine, it is not the whole story. There are broadly four categories of technology that could potentially have a significant impact either on patient outcomes or on health system implementation. These include technologies for greater molecular characterisation of individuals or disease, such as genomics; technologies for personalised therapeutic interventions, such as stem cell therapy and genome editing; technologies for personalised disease and health monitoring, consumer health apps and digitally-enabled wearables; and enabling technologies to transform the performance or capabilities of other technologies, such as artificial intelligence and machine learning.
Crucially, personalised medicine can also benefit the NHS, as it has the potential to streamline care pathways. There’s great value in the multidisciplinary team when it comes to cancer care (a range of experts from across the pathway who can discuss a patient’s diagnosis and treatment) but this could be made more efficient through the use of new technologies.
We are already looking at how to do this. Roche Diagnostics has been involved in a collaborative venture, the Northern Pathology Imaging Cooperative (NPIC) in Leeds, to pioneer the use of artificial intelligence (AI) in digital pathology. We hope this partnership will help the system to run more efficiently as digital pathology makes it possible to scan and create digital images of microscope slides, so they can be shared between hospitals more easily. This will revolutionise how cancer is diagnosed. It’s wonderful to be able to work with brilliant people on algorithms that can speed up diagnosis and the characterisation of a patient’s cancer. It really exemplifies the ‘personal’.
Professor Dame Sue Hill, SRO for Genomics at NHS England, has described personalised medicines as central to transforming the health system, and she’s right. But as well as benefiting the system, new developments in personalised medicine can offer new hope to patients where there have previously been few options.
Companion diagnostic tests are also a key part of this, and of personalised cancer treatment in general, because they can be used to determine how the patient will respond to certain treatments, and which treatment will work for which patient using genomic profiling and biomarkers. This benefits the patient, as they are able to receive the most appropriate care, and benefits the health system, as it enables treatments to be used appropriately.
One of the benefits of Roche is that we have both diagnostic and pharmaceutical functions. We have worked with our pharmaceutical colleagues to develop an innovative test to determine whether a new treatment will benefit patients with triple negative breast cancer (TNBC), the very type of cancer that my colleague’s mother sadly died from. This type of breast cancer is one of the toughest forms to treat; it is highly aggressive, accounting for around 15% of all cases. It is also more likely to recur than other breast cancers and is associated with poorer survival. TNBC exemplifies a tumour type where there have been limited treatment options. Being able to work towards pushing the envelope on treatment options when you’ve seen the real world impact on a patient is a privilege I have being a part of the life sciences industry at the cutting edge.
Of course, real-world data is the cornerstone of enabling personalised medicine to work. Data from the clinic can accelerate basic discovery in the lab, and potentially lead to the improvement of existing medicines, the discovery of new combinations or the development of new treatments. Personalising cancer medicines further depends on high-quality diagnostics that can match patients to precisely targeted therapies.
It’s no secret that personalised medicine necessitates the gathering and processing of huge amounts of data, and the public, rightly, cares about who handles their personal healthcare data and how it is handled. As a company, Roche has years of experience in taking and managing people’s data, especially via clinical trials, so we collectively have the processes and platforms in place to work safely and effectively with patient data. This is something which, arguably, tech companies do not have. I believe that it is vital for leaders in medical technology and the life sciences to build trust in the way that they handle data. It is imperative that we steer through this new frontier and develop trust with patients highlighting that their data is not only in safe hands, but that it is used to improve collective learning that will benefit more patients.
In the future, we are also more likely to see partnering between companies. This is something we are already doing, for example through our collaborative relationship with diagnostics company Illumina to provide broad access to clinical oncology next-generation sequencing. These partnerships allow for the most complementary sharing of skills and resources to work towards the common good.
There are many exciting innovations at work, and I am proud to be a part of what I truly believe will be revolutionary to how we treat cancer. If there’s one thing I am absolutely sure about, it is that the challenge in the personalised cancer care frontier will not be solved by any one contributor. I believe it is only through working in partnership that we can achieve a standard of personalised medicine that will take us into the future.
Geoff Twist is managing director, Roche Diagnostics UK and Ireland