Personalized medicine: how to manage it autonomously?

If they exist two “keys” of health guarantee Personalized medicine success throughout Spain, this precision prevention (early detection of diseases) and molecular diagnostics. But the implementation of these methods is not an easy task, and differences between autonomous communities mean that different voices in the sector increase the guarantee of their progress throughout the territory to move towards quality precision medicine. In a discussion organized Medical letter in collaboration with Roche Farma Spain was analyzed What are your plans to promote personalized medicine? carried out in communities and, if sufficient, a combination of detection and diagnosis of various tumors or even the use of artificial intelligence tools applied to this.

For Carmen DuranDirector General of Public Health of the Ministry of Health of the Government of Galicia, the success of the implementation of these plans at the regional level depends on have a “significant budget” and a shared health data repository collect all the information from communities: “If we want to take a step forward, let’s do it with a budget. To achieve effective development, it is also important that we have a common repository of health data, information sharing or standard operating procedures in all communities“, Explain.

Federico Rojo, director of the department of molecular pathology at the Jiménez Díaz Foundation Hospital, notes that these plans are “already too late.” “We know that in some areas 30 or 40 percent of patients do not have access to molecular diagnostics. or into precision medicine, because there are no resources in this community to do this, and this is serious,” he points out, and also adds that it is necessary to formulate an overall strategy to achieve this goal.

Steps forward in personalized medicine

Significant advances have been made in the field of personalized medicine. Making more progress in early diagnosis using not only environmental risk factors but also human polygenic risk factors could help, according to Luis Paz-Areshead of the hospital’s oncology service on Oct. 12 to have more accurate predictions of “which patients should be at risk.”

Luis Paz-Ares, director of the oncology service at the 12 October Hospital and Beatriz Bellosillo, director of the molecular biology department of the pathological anatomy service at the del Mar hospital.

“In a way it’s to a certain extent universalize this precision prevention or early diagnosis.. I think this is a reality and we are getting more knowledge and better technology. It probably won’t be available tomorrow or for all patients, but I think we’ll see a lot of progress in this regard over the next ten years. To do this, we must demonstrate convincingly that these studies do what they are supposed to do: early diagnosis and prevention, and the ability to implement population-based designs that actually reinforce what the experimental studies have told us. Today we have examples where early diagnosis is effective, but we still don’t do it, as with lung cancer. We have very reliable data for more than ten years and we still do not have a clear implementation plan in the country, as required by Europe and especially the countries around us,” he admits.

New professional profiles in the field of personalized medicine

Experts also discussed the growing need after achieving a “strong commitment” in all autonomous communities. The development of personalized medicine must go hand in hand with creation of new professional profiles they should be included in the health care system, since there are currently profiles that are “not even currently included as such” in the health care system.

Beatriz Bellosillo, Head of the Department of Molecular Biology of the Pathological Anatomy Service of the Hospital del Mar, emphasized the importance of training staff on how to understand the generated data, interpret it correctly and convey it to the end client, who for us is the doctor who will make decisions for the patient. “This is another one of the things that I think is being worked on now from different angles: we have to plan for these health profiles. Typically most interpretations of data requires profiles that have not yet been provided“He’s analyzing.

Moment from the discussion “Early detection and precision diagnostics within the framework of personalized medicine: realities and challenges” Medical letter in collaboration with Roche.

Federico Rojo emphasizes that today the possibility of incorporating these specialized profiles (molecular biologists and statisticians) into the public health system is not always considered in all communities. “It’s not always feasible, and many of the people we train or teach this type of technology who don’t have a regular type of contract within the system often resort to formulas within research projects, research foundations and I think that too This is the obstacle we need to overcome to achieve full realization“, Add.

Artificial Intelligence Tools

Implementation of tools Artificial intelligence for the development of personalized medicine Some communities are developing. In the case of Galicia, Carmen Duran analyzed the use of this AI for breast screening. “What we do is radiologists read mammograms in pairs, and we have now included a third part, which will be an artificial intelligence tool. We’re starting with 35,000 tests and then we’re going to evaluate whether it’s worth continuing.” with them. But we believe that the important element is the ability incorporate AI into breast cancer screening“Says Duran. They implemented something similar in colon cancer screening using a special tool in all hospitals.

In addition, Durant points to two other artificial intelligence projects, one of which concerns lung cancer screening based on a lung cancer risk stratification algorithm. On the other hand, another project at European level, focused on prostate cancer screening, stands out: “This algorithm also stratifies the risk and assumes that the biopsies performed are the minimum possible, and for this there are various intermediate steps. We are talking about personalized medicine. This public health cure must go hand in hand with AI because we need huge databases from which we have to extrapolate results,” he says.

“A strong commitment to personalized medicine in autonomous communities must go hand in hand with the creation of new professional profiles.”

The role of the pharmaceutical industry in personalized medicine

The debate has also left room, among many other aspects of precision medicine, for being able to know What role does the pharmaceutical industry play? in her. Teresa RamosHead of Personalized Medicine at Roche Pharma, notes that their “initial mission” will be to develop new innovative treatments for cancer patients, but assures that for many years they have seen that this is “not enough”: “There is other unmet medical needs and we have been working for some time to develop the medical technologies that accompany this arsenal of new treatments. And first of all, we work in two areas in terms of health technology. Firstly, in digital health, that is, any information or communication technology that helps us promote better health or patient care,” he admits.

Teresa Ramos, Head of Personalized Medicine at Roche Farma; Federico Rojo, Director of the Department of Molecular Pathology of the Jiménez Díaz Foundation Hospital and Carmen Durán, Director General of Public Health of the Ministry of Health of the Government of Galicia.

Another pillar, besides digital health, that Ramos emphasized is related to genomic tumor diagnostics to determine the most effective treatment for each patient, with the goal accompany professionals and the scientific community in collecting evidence is also necessary when measuring outcomes: “What will it mean for me to introduce this new technology into clinical practice and what impact will it have on health outcomes? Obtaining these data will help us accelerate the translation of these technologies into clinical practice. We are trying to support the pharmaceutical industry with tools, technologies and evidence, clinical trials that help us understand how we should use these technologies,” he concludes.

Health authorities and accurate diagnosis

European countries have developed plans for precision medicine and access to molecular diagnostics “for many years”, and for Federico Rojo the model that “we all have in mind” is France, since it has a network of centers that guarantee all patients access to molecular diagnostics using highly effective methods. The situation is not the same as in Spain, but it is recognized that something is changing. “In June we had for the first time publication of a portfolio of services in the field of genetics and genomics which included something that had never been written, namely the diagnosis of somatic changes within the framework of the concept of precision medicine, for prescription for medicine. This is the result of three years of work with a group of experts who advised the ministry, and with representatives of all autonomies,” he admits.

Rojo claims it was used to give him momentum and turn him on biomarkers that will be needed in 2023 for the diagnosis and treatment of cancer patients. “This publication includes for the first time a list of tests that any cancer patient should have access to within the NHS, and it is now the responsibility of the devolved communities to develop implementation plans and ensure access to these tests. Let us not forget that in a decentralized system such as ours, in addition to the publications of the Ministry, each territory must clearly define how to develop and how to cover this portfolio of services in each community,” he reminds. Although this is not the same in all cases, Rojo insists that this is the first step, “the first stone on the path” to precision medicine policy and strategy.

Debate “Early detection and precision diagnosis within the framework of personalized medicine: realities and challenges” on the topic “Medical writing”.