A New World of Precision Medicine

A new world — that’s how Peter Byers, M.D., describes precision medicine. Byers should know: he’s the director of UW Medicine’s new Center for Precision Diagnostics.

In our main feature, we talked to Byers and a number of other faculty about their work in breast cancer, Alzheimer’s disease and macular degeneration. However, precision medicine — using high-tech methods to focus treatment on a single patient — touches other areas in medicine and has many proponents. We’ve collected some of their thoughts below.

MORE OPTIONS FOR CANCER TREATMENT

Question for Pam Becker, Institute for Stem Cell and Regenerative Medicine and Center for Cancer Innovation.
We know you’ve been working with the Quellos High-throughput Screening Core to test compounds against acute myeloid leukemia. What’s your progress to date?

A: At this time, we can only cure about one-quarter of all patients with acute myeloid leukemia (AML), and the rest relapse after treatment, usually within one year. We treat these patients initially with a standard two-drug regimen, as there are very few drugs that are approved for AML by the U.S. Food and Drug Administration.

On the other hand, DNA sequencing of the genetic code of leukemia cells from patients with AML has shown that each patient’s leukemia is unique. On average, each patient has a unique set of approximately 13 mutations, and, in fact, more than 260 mutations were found that occurred in more than one patient. Given this level of complexity, it makes sense that there should be a personalized treatment based on the individual’s form of cancer.

So we decided to test a patient’s cells against a panel of 160 drugs in UW Medicine’s high-throughput facility; it’s a process that takes about five days. So far, we have enrolled 11 patients in our study who have been treated with the drugs we identified by testing (rather than the standard options). Some of these drugs are not usually used with AML. It’s too soon to give response data, but our hope is that the patients will respond well — and that we will have more drug options to for patients with the disease.

Pamela S. Becker, M.D., Ph.D.
UW Associate Professor of Medicine, Division of Hematology

LEARNING WITH PATIENTS

Question for Gail Jarvik, medical geneticist.
What are you learning from working closely with patients and precision medicine?

A: We’re tracking our early experiences with using next-generation genetic tests: they cover dozens of genes, instead of only a few. We’ve found that there are a surprising number of patients for whom the genetic cause of their disorder is not one of the more common genetic causes. We’re also finding that disorders thought to be very rare are not as rare as advertised.

These results suggest that genomic data will not only help solve the cause of disease in the patient we’re seeing that day, but that our better understanding of the genetic basis of disease (common ones, like cancer, and rare ones, like some neurological diseases) will help us to treat illnesses in the patients that follow. In that way, we are partners with our patients in solving their health concerns and in gaining knowledge that very quickly helps others. This is the advantage of an academic medical center.

Gail P. Jarvik, M.D., Ph.D., Fel. ’91
UW Professor of Medicine and Head, Division of Medical Genetics
Arno G. Motulsky Endowed Chair

A VITAL TOOL AGAINST CANCER

Question for Colin Pritchard, one of the developers of UW-OncoPlex™, a high-accuracy, low-cost tool used to do genetic sequencing in the clinic.
The last time we talked, you mentioned that UW-OncoPlex™ might be used for an even wider range of applications for cancer patients?

A: That’s correct. As one example, in collaboration with Peter Nelson, M.D., and other colleagues, we have begun to use the UW-OncoPlex™ test for men with prostate cancer. For higher-risk patients that meet certain criteria, this testing is being funded by the Institute for Prostate Cancer Research [a collaboration between UW Medicine and Fred Hutchinson Cancer Research Center]. It’s an exciting opportunity to apply genomic information to help guide treatment decisions for men with prostate cancer.

Second, in collaboration with Tony Blau, M.D., we’re using the UW-OncoPlex™ test in combination with other genomics tools to help better characterize a particularly dangerous type of breast cancer known as triple-negative. Third, in collaboration with colleagues in multiple departments here and at the Hutch, we have begun to incorporate the tool into the design of clinical trials for new types of targeted inhibitors to treat cancer. And we’re adapting the UW-OncoPlex™ test to identify exciting new kinds of mutations in cancer DNA that were not previously detectable using next-generation sequencing” technology. These are just a few examples of what we’re doing locally and nationally with UW-OncoPlex™.

Colin C. Pritchard, Ph.D.’05, M.D. ’07, Res. ’10
UW Assistant Professor, Department of Laboratory Medicine

UW MEDICINE, EVOLVING.

Question for John Slattery, Ph.D., vice dean.
How is UW Medicine equipped to take on precision medicine?

A: Precision medicine requires the ability to evaluate the workings of the chemical systems driven by genes, proteins and small-molecule metabolites — and this evaluation has only been achieved in research laboratories. Taking this kind of medicine from the lab to the clinic is another process altogether.

The first step is to relate these molecular processes to disease in individual patients: to understand how molecular events play somewhat differently throughout the affected population and how these events relate to a specific patient. That takes world-class expertise in the clinic linked with world-class expertise in a variety of research areas, as well as outstanding informatics and data analysis capabilities. UW Medicine has been continually building these capabilities since the School of Medicine was founded in 1946, and precision medicine is simply the next step in our evolution.

John T. Slattery, Ph.D.
Vice Dean for Research and Graduate Education

Read the feature on precision medicine.

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