Targeting cancer and careers: Precision MedicineMar 01, 2019 · n the field of oncology,...
Transcript of Targeting cancer and careers: Precision MedicineMar 01, 2019 · n the field of oncology,...
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The migration away from “one-size-fits-all” medicine, particu-larly in the areas of cancer detection and treatment, holdsgreat promise for patients and the field of precision medicine.Demand and jobs are increasing for researchers, clinicians,and professionals who are at home collecting, analyzing, andusing more and newer forms of data. By Ellen R. Delisio
In the field of oncology, innovations continue to growrapidly in precision, or targeted medicine, as cliniciansseek to find better treatments for specific kinds of cancer,rather than take a blanket approach via the traditional
trifecta of radiation, chemotherapy, and surgery. To do so, theymust test patients, note mutations, and identify biomarkers todetermine what treatments could work best with the fewestside effects.
Scientific breakthroughs, in these areas and more, have ledto greater understanding of genes and their functions andhave created new opportunities for precision medicine—andfor those with technical, research, and clinical skills eager towork in this ever-expanding field. Special consideration will begiven to those job applicants who can perform big data analy-sis and multidisciplinary research. However, new jobs will alsoemerge in previously unseen areas, such as business, transla-tional medicine, and genetic counseling.
“The theory of precision medicine is exciting and clear—deliver the right medicine, at the right time, to the rightpatient. But, in practice, it can be quite challenging—identify-ing how to develop a medicine with the right biomarker isactually really tough,” says Thomas Hudson, vice president,oncology discovery at AbbVie, a biopharmaceutical companywith a major interest in cancer research, headquartered inLake Bluff, Illinois. “It will take the collective efforts of multiplestakeholders coming together.”
Government projects lend a hand
New and powerful tools have aided the precision medicinemovement. The Human Genome Project, the first completemapping of human genes, published its preliminary results in2001. The project’s numerous benefits include knowing thelocation of the approximately 20,500 genes identified in thebody and gaining a clearer understanding of how genes areorganized and operate.
“The Genome Project has significantly improved our abilityto learn how tumor cells work at the molecular level—the morewe learn their inner workings, the better we’re able to de-velop effective therapies,” says Andrea Califano, chair of theColumbia University Department of Systems Biology, directorof the JP Sulzberger Columbia Genome Center, and associatedirector for Bioinformatics of the Herbert Irving Comprehen-sive Cancer Center, in New York City. “Right now, we con t .>P
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Targeting cancer and careers:Precision Medicine
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Companies get into the actOne of the fastest-growing precision medicine approaches,
thanks to the availability of more genetic information, is thedevelopment of cancer drugs that target specifc types of cancerand are effective in individuals with a particular genetic makeupor biomarker.
“Now we understand the genetic architecture of each cancer.Sometimes it is better to know the genetic basis of cancer ratherthan its location. Drugs are being developed based on cancer’sgenetic vulnerability rather than [on] tissue of origin,” says ChrisBoshoff, chief development offcer at Pfzer Oncology in NewYork City, citing as an example the fact that lung cancer hasat least 10 different subtypes. Currently, Pfzer has 14 cancerdrugs approved, and out of those, seven are based on precisionmedicine and target a specifc subtype of lung cancer, he says.
Some companies are even more specialized, such as LoxoOncology in Stamford, Connecticut, (recently acquired by EliLilly), which focuses on treatments for cancers caused by asingle DNA abnormality. A single drug could have a dramaticeffect on that type of cancer.
“I’m excited about the work—you take a biopsy of a tumor anduse next-generation sequencing to identify alterations in theDNA or RNA that indicate why it became cancer in the frst placeand help you identify vulnerabilities against which we can usedrugs,” says Loxo’s CEO Josh Bilenker.
One new trend in precision medicine is noninvasive testing,according to a statement from Novartis. While cancer istraditionally diagnosed with solid tumor biopsies, somescientists are using blood tests known as liquid biopsies,followed by genomic analysis of fragments of tumor DNA foundin the bloodstream. These DNA remnants reveal the kinds ofmutations that may be driving a patient’s cancer and couldprovide clues about how to treat it. Novartis researchers havebeen developing liquid biopsy technologies for several yearsand are now working to make them a reality in clinical practice.
Novartis has also launched several targeted medications,such as Gleevec, which was the frst in a new class of drugsfor precision medicine known as tyrosine kinase inhibitors.Gleevec treats forms of leukemia—chronic myelogenous leuke-mia and acute lymphocytic leukemia—that were often deadly inthe past, but are now treatable, chronic diseases.
Overcoming obstaclesDeveloping precision medicine treatments is not without
challenges. These include the cost of testing and implementa-tion, the fckle and resilient nature of cancer, and the volumesof data and regulations that researchers must deal with. Lack ofuniformity in testing also hinders the feld.
The complexity of drug discovery and development can alsoslow progress. Enter Harvard Business School’s Kraft PrecisionMedicine Accelerator, whose mission is to streamline process-es so patients get treatments sooner. “We’re trying to applybusiness thinking to blockages in the system,” says RichardHamermesh, faculty cochairman of the accelerator.
The initiative was funded by a USD 20 million endowmentfrom Robert Kraft, owner of the New England Patriots. Kraft’swife, Myra, died from ovarian cancer, and received targetedtherapy late in her treatment, but her disease had progressedtoo far. “The experience made him realize there is a lot of fric-tion in the system. If it could be eliminated, treatments couldcome to market faster,” says Hamermesh.
know that using drugs targeting specifc molecular dependen-cies of the cancer cell leads to signifcant increase in response.We expect that the future of medicine is going to be even morepredictive, rather than being based on trial and error.”
The next big game-changer was the Precision MedicineInitiative, launched by President Obama in 2015, with USD215 million in the 2016 federal budget. The allocation includedUSD 70 million for the National Cancer Institute (NCI) at theU.S. National Institutes of Health (NIH) in Bethesda, Maryland,to accelerate programs to single-out genomic drivers of cancerand to use that knowledge to create more effective treatments.Also part of the package was USD 130 million for NIH to collectthe health profles of 1 million Americans and establish a data-base that can be shared and used for research.
Called All of Us, the database project aims to gatherinformation from as many different segments of the populationas possible, says Kelly Gebo, M.D., M.P.H., chief medical andscientifc offcer of the All of Us Research Program. “We knowdifferent people respond to different types of medicines,”says Gebo. “We’re trying to do research on a diverse group ofpeople that traditionally have not been included in biomedicalresearch.”
While researchers often look at factors such as gender, All ofUs is recording other information including age, income, andeducation. “We want to try to look at [these other] differencesin populations and how they affect clinical outcomes in thefeld,” Gebo says.
Since the program launched on May 6, 2018, 150,000volunteers have registered, 90,000 of whom have supplieddata about their health and family history. The goal is to havepeople stay with the program for several years, updating theirhealth information. NIH has gone to great lengths to ensureparticipants’ privacy and intends to create a data platform thatcan be used by all scientists, as well as other companies andindividuals.
“This is going to be a tremendous data resource that allowsus to look at information we never could before,” continuesGebo. “I look forward to researchers getting their hands dirtyas they look into the data.” con t .>
ÒBig data needs clever, thoughtful analysis.Ó
Ñ Benedict C. S. Cross
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Califano concurs. “Thereis going to be a tremendousrequirement for analyticalpipeline specialists—peoplewho are able to performsophisticated data analysis,”he says.
Wanted: Multitalented
individuals
Precision medicine, andthe life sciences in general,have become increasinglymultidisciplinary and col-laborative, explains Ho, andrequire professionals with
multiple skill sets. “A degree of Cuency in one or more feldsoutside an area of core expertise is needed in order to effec-tively communicate across disciplines,” he says.
Cross agrees. Bench scientists, computational scientists,geneticists, and other researchers will need to be able to syn-thesize many different types of information, he notes.
The wealth of existing data could also create the demandfor more professionals to help patients process it, observesCalifano. “I see a need for more genetic counselors,” he says.“When you get the whole genome, you see what else is there.If something is found by chance, should the patient be noti-fed? It could be a fairly complicated process.”
Two new professional opportunities in precision medicinestem from the translational medicine and cellular and com-putational biology felds, says Klaus Hoefich, vice president,biology, at Blueprint Medicines, with headquarters in Cam-bridge, Massachusetts and Zug, Switzerland. The companydevelops precision therapies that selectively target proteinkinases, key signaling enzymes that are proven drivers of can-cer progression.
Translational medicine in this arena involves applying ad-vances in sequencing and biomarker assays to identify whichpatients are most likely to respond to treatment. “An emergingresearch area is to advance patient selection in immuno-oncology and immunology to make it more like precisionmedicine,” HoeCich says.
Cellular and computational biology will be called upon moreand more to manage in-depth analysis of a broad range ofdata. “We are increasingly integrating additional molecularand genomic data, including from tumor and liquid biopsies,via machine learning and artifcial intelligence, to reveal newinsights,” says HoeCich.
As entities form partnerships, explore licensing, anddevelop marketing and distribution plans for new products,opportunities will open up for business professionals, saysHamermesh, adding that the Harvard Business School’s KraftPrecision Medicine Accelerator was not started to create jobs.
And growth is continuing, asserts Califano. “We are in theinfancy of precision medicine—we are setting the stage forwhat the future will be.”
Featured participants
To accomplish that goal, for the past three-and-a-half years,the accelerator has been working with groups to build patientregistries and facilitate data collection and sharing. The easierit is to fnd patients, the more quickly clinical trials can bescheduled, says Hamermesh. “Nothing we’re doing is going tobypass physicians or researchers,” he adds. “We’re looking tomake their jobs easier.”
Opportunities galoreAs precision medicine grows and evolves, so will job
opportunities, and not just for researchers and clinicians,although they will continue to make up the major share of theworkforce.
“Career opportunities in precision medicine encompassa broad, multidisciplinary spectrum of capabilities, and alsorange from the discovery and preclinical [stages] to clinicaldevelopment settings,” says Steffan N. Ho, vice president andhead of translational oncology at Pfzer, adding that key jobcandidates will be individuals with expertise in cancer biology,immunology, bioinformatics, clinical laboratory science,and platform technologies supporting sample analysis anddiagnostic test development.
At AbbVie, the number of people working in precisionmedicine in the oncology department grew from 30 to 60 intwo years, says Hudson. “I see a lot of growth [for precisionmedicine] in pharmaceutical and diagnostic companies,” hesays. “Companies will also need more specialized people whocan analyze biomarkers and look at tissue samples.”
Data analysts will be some of the most sought-afterpersonnel, professionals agree, since the volume ofinformation coming from multiple sources will continueto grow.
“Big data needs clever, thoughtful analysis,” says BenedictC. S. Cross, head of functional genomic screening atHorizon Discovery, a translational genomics company basedin Cambridge, England, which supplies pharmaceuticalcompanies, researchers, and academia with cell lines thathave been genetically modiDed to mimic diseases. “The moredata you have, the greater the chance of better outcomes.”And the faster that data can be processed, the faster it can betranslated into treatment options, he says.
AbbVie
www.abbvie.com
All of Us Research Program,National Institutes of Healthallofus.nih.gov
Blueprint Medicineswww.blueprintmedicines.com
Califano Laboratory of SystemsBiology, Columbia Universitycalifano.c2b2.columbia.edu
Horizon Discoverywww.horizondiscovery.com
Kraft Precision Medicine
Accelerator, Harvard Business
School
www.hbs.edu/kraft-accelerator/pages/default.aspx
Loxo Oncologywww.loxooncology.com
Pfizer Oncologywww.pfizer.com/partnering/areas_of_interest/oncology
Ellen R. Delisio is a freelance writer who specializes in the sciences and
education. She is based in Connecticut.
Josh Bilenker
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