Precision medicine's Holy Grail: Anticipate cancer's next step
ORLANDO ― At the Precision Medicine Symposium on Sunday, Intermountain’s gastrointestinal medical oncology director, Mark Lewis, MD, outlined both the challenges and solutions to cancer treatment.
“Our Holy Grail isn’t just to treat now, but to anticipate what cancer is going to do,” Lewis said, adding, “Cancer is a Darwinian nightmare, with millions of cells competing for survival. If we can anticipate the changes, we may be able to get ahead of it.”
Lewis’ opening keynote at Sunday’s HIMSS17 Precision Medicine Symposium highlighted the results of Intermountain’s precision medicine program, which has reduced cancer treatment costs and improved patient outcomes. Intermountain Healthcare is located in Salt Lake City, Utah.
Lewis described the patient’s journey, which begins at Intermountain’s precision medicine clinic, followed by a biopsy or FFPE and pathology review. The sample is prepped for molecular analytics, and a molecular tumor board creates a personalized treatment. The process should take two weeks or less from patient entry to results.
“To take longer than that is truly doing a disservice to patient care,” Lewis said. “Cancer doesn’t wait.”
But a single sample can’t allow researchers to understand the complete genomic architecture of cancer, Lewis explained. “EMRs, and even our own data warehouses, can’t compute the volume of genomic data and aren’t well-suited to the workflow. And there isn’t an excellent mechanism for outcome tracking.”
“Infrastructure for managing genomic data is absent at most institutions,” he said. True implementation comes from measurement outcomes and a clinical champion. There needs to be at least one doctor who invests in precision medicine.
Interoperability is also a challenge, as there’s no real industry standard. HL7 has made great use of FHIR, but it’s not yet used in labs.
“The only way we’re going to move the standard of care ahead for cancer is with research,” he said. “What genomics is helping us do is to be smarter about how we treat cancer.”
And precision medicine needs to be a global effort, Lewis explained, and that it’s also imperative organizations use specialized tools like Syapse, which streamline precision medicine data in EHR clinical workflows.
“What we’re trying to do here is find things that are actionable and make a difference in a patient’s care,” he said.
Intermountain has generated a large pool of data, which can be used to determine the best course of action for each patient. Patients can be matched to conventional therapies or clinical trials.
“Having the data is one thing, but being able to act on that information is another thing entirely,” Lewis said. “This is not an academic exercise: This is trying to better patient care.”
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.