Complexity of Delivering Precision Medicine: Opportunities and Challenges.

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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.





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Davis, Andrew A, Amy E McKee, Warren A Kibbe and Victoria M Villaflor (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

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Warren Alden Kibbe

Professor in Biostatistics & 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 served as an acting Deputy Director for NCI. As an acting Deputy Director, Dr. Kibbe was involved in the myriad of activities that NCI oversees as a research organization, as a convening body for cancer research, and as a major funder of cancer research, funding nearly $4B US annually in cancer research throughout the United States. 

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