Personalised medicine: the role of genetics

Consultant pharmacist STEVE WILLIAMSON and Dr ANGELA SILMON consider some of the issues associated with new diagnostic testing platforms for cancer treatments and specific molecular targets.

 The concept of personalised medicine is fast becoming a reality. Traditionally, cancer treatment regimens evolved by combining drugs that showed in vitro activity in the lab against specific tumour types, followed by clinical trials to prove activity in the real world. However, as our understanding of the molecular biology of tumours has grown, researchers have successfully discovered new molecular targets to enable cancer treatments to be targeted to those patients most likely to respond. The hope is that by focusing on molecular and cellular changes that are specific to cancer, targeted therapies may be more effective than other types of treatment, including chemotherapy and radiotherapy, and less harmful to normal cells. However, in order to exploit the growing knowledge of molecular targets, new genetic detection and diagnostic techniques have had to be developed, proven and introduced into clinical practice. In 2012, a strategic vision for how the healthcare system in the UK can benefit from the mainstream adoption of genomic technology was provided by a report from the Human Genetics Strategy Group (HGSG), Building on our inheritance – Genomic technology in healthcare.1 The report highlighted the prominent view across medicine that, as understanding of the molecular basis of disease becomes more widespread and encompasses far more than hereditary conditions, the demand for molecular diagnostics will increase significantly and will gradually change established diagnostic methods across pathology. For this to happen, an entirely new genetic diagnostic testing service will be needed to meet the future demand for testing for biomarkers associated with new medicines.

Implications for commissioning cancer medicines in UK