Complexity of Delivering Precision Medicine: Opportunities and Challenges.
Abstract
Precision medicine has emerged as a tool to match patients with the appropriate treatment
based on the precise molecular features of an individual patient's tumor. Although
examples of targeted therapies exist resulting in dramatic improvements in patient
outcomes, comprehensive genomic profiling of tumors has also demonstrated the incredible
complexity of molecular alterations in tissue and blood. These sequencing methods
provide opportunities to study the landscape of tumors at baseline and serially in
response to treatment. These tools also serve as important biomarkers to detect resistance
to treatment and determine higher likelihood of responding to particular treatments,
such as immune checkpoint blockade. Federally funded and publicly available data repositories
have emerged as mechanisms for data sharing. In addition, novel clinical trials are
emerging to develop new ways of incorporating molecular matched therapy into clinical
trials. Various challenges to delivery of precision oncology include understanding
the complexity of advanced tumors based on evolving "omics" and treatment resistance.
For physicians, determining when and how to incorporate genetic and molecular tools
into clinic in a cost-effective manner is critical. Finally, we discuss the importance
of well-designed prospective clinical trials, biomarkers such as liquid biopsies,
the use of multidisciplinary tumor boards, and data sharing as evidence-based medicine
tools to optimally study and deliver precision oncology to our patients.
Type
Journal articleSubject
HumansNeoplasms
Prognosis
Treatment Outcome
Clinical Trials as Topic
Molecular Targeted Therapy
High-Throughput Nucleotide Sequencing
Biomarkers, Tumor
Precision Medicine
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https://hdl.handle.net/10161/17834Published Version (Please cite this version)
10.1200/edbk_200279Publication Info
Davis, Andrew A; McKee, Amy E; Kibbe, Warren A; & Villaflor, Victoria M (2018). Complexity of Delivering Precision Medicine: Opportunities and Challenges. American Society of Clinical Oncology educational book. American Society of Clinical
Oncology. Annual Meeting(38). pp. 998-1007. 10.1200/edbk_200279. Retrieved from https://hdl.handle.net/10161/17834.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Warren Alden Kibbe
Professor in Biostatistics and Bioinformatics
Warren A. Kibbe, PhD, is chief for Translational Biomedical Informatics in the Department
of Biostatistics and Bioinformatics and Chief Data Officer for the Duke Cancer Institute.
He joined the Duke University School of Medicine in August after serving as the acting
deputy director of the National Cancer Institute (NCI) and director of the NCI’s Center
for Biomedical Informatics and Information Technology where he oversaw 60 federal
employees and more than 600 contractors, and serv

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