Personalized medicine: biomarkers and companion diagnostics
DOI:
https://doi.org/10.7175/fe.v19i1.1348Keywords:
Personalized medicine, Companion diagnostics, BiomarkersAbstract
Great expectations are bound to the current evolution of medicine to personalized medicine. Thanks to rapid advances in genomics and molecular biology, new markers can be revealed for the presence of or susceptibility to a disease, or response to treatment. On such markers, diagnostic tests can be based; companion diagnostics (CDx, often called In Vitro devices) are diagnostic tests “coupled” with a therapeutic drug, aimed at assessing its applicability to a specific class of patients. As well as exemplifying some already implemented CDx applications, the purpose of this article is to highlight potentials and problems of personalized medicine today. In particular, the opportunity is analyzed for the co-development of a new drug and its CDx, through a parallel base research. This approach is promoted by the regulatory agencies but, due to scientific and economic factors implicit in the process, it is taking-off slowly. Personalized medicine deserves to grow and to expand, first of all because it simultaneously promises to substantially improve patient care and to make big costs savings for healthcare systems. From this point of view, all stakeholders (diagnostics manufacturers, clinical testing laboratories, pharmaceutical firms, the Department of health, and other bodies) should talk to each other in order to support the advancement of personalized medicine.
References
European Commission 25.10.2013 SWD(2013) 436 final: Commission staff working document: Use of ‘-omics’ technologies in the development of personalised medicine. Available at https://ec.europa.eu/research/health/pdf/2013-10_personalised_medicine_en.pdf (last accessed December 2017)
President’s Council of Advisors on Science and Technology. Priorities for Personalized Medicine. September 2008. Available at https://www.hsdl.org/?view&did=234678 (last accessed December 2017)
Rodriguez-Antona C, Taron M. Pharmacogenomic biomarkers for personalized cancer Treatment. J Intern Med 2015; 277: 201-17; https://doi.org/10.1111/joim.12321
Malapelle U, Sirera R, Jantus-Lewintre E, et al. Profile of the Roche COBAS® EGFR mutation test v2 for non-small cell lung cancer. Expert Review of Molecular Diagnostics 2017; 17: 209-15; https://doi.org/10.1080/14737159.2017.1288568
Thorne-Nuzzo T, Williams C, Catallini A, et al. A Sensitive ALK Immunohistochemistry Companion Diagnostic Test Identifies Patients Eligible for Treatment with Crizotinib. J Thorac Onco 2016; 12: 804-13; https://doi.org/10.1016/j.jtho.2017.01.020
U.S. Food & Drug Administration. Companion Diagnostics. Available at https://www.fda.gov/medicaldevices/productsandmedicalprocedures/invitrodiagnostics/ucm407297.htm (last accessed December 2017)
Donovan MJ, Cordon-Cardo C. Implementation of a Precision Pathology Program Focused on Oncology-Based Prognostic and Predictive Outcomes. Mol Diagn Ther 2017; 21: 115-23; https://doi.org/10.1007/s40291-016-0249-5
European Medicines Agency. Concept paper on predictive biomarker-based assay development in the context of drug development and lifecycle. 2017. EMA/CHNP/800914/2016. Available at http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2017/07/WC500232420.pdf (last accessed December 2017)
Degeling K, Koffijberg H, IJzerman MJ. A systematic review and checklist presenting the main challenges for health economic modeling in personalized medicine: towards implementing patient-level models. Expert Rev Pharmacoecon Outcomes Res 2017; 17: 17-25; https://doi.org/10.1080/14737167.2017.1273110
Wulfkuhle JD, Spira A, Edmiston KH, et al. Innovations in Clinical Trial Design in the Era of Molecular Profiling.- Molecular Profiling: Methods and Protocols, Methods in Molecular Biology. Vol 1606. New York: Humana Press, 2017
Dearden S, Brown H, Jenkins S, et al. EGFR T790M mutation testing within the osimertinib AURA Phase I study. Lung Cancer 2017; 109; 9-13; https://doi.org/10.1016/j.lungcan.2017.04.011
Cheng MM, Palma JF, Scudder S, et al. The Clinical and Economic Impact of Inaccurate EGFR Mutation Tests in the Treatment of Metastatic Non-Small Cell Lung Cancer. J Pers Med 2017; 7; https://doi.org/10.3390/jpm7030005
Luo D, Smith JA, Meadows NA. A Quantitative Assessment of Factors Affecting the Technological Development and Adoption of Companion Diagnostics. Front Genet 2016; 6: 357; https://doi.org/10.3389/fgene.2015.00357
Tímár J, Ladányi A. Predictive markers of immunotherapy of cancer, practical issues of PD-L1 testing. Magy Onkol 2017; 61: 158-66
Nagy Z. Biomarkers in solid tumors. Magy Onkol 2013; 57: 56-62
Berry DA. The Brave New World of clinical cancer research: Adaptive biomarker-driven trials integrating clinical practice with clinical research. Mol Oncol 2015; 9: 951-9; https://doi.org/10.1016/j.molonc.2015.02.011
Nenadić I, Staber J, Dreier S, et al. Cost Saving Opportunities in NSCLC Therapy by Optimized Diagnostics. Cancers 2017; 9: 88; https://doi.org/10.3390/cancers9070088
Brüggenjürgen B, Kornbluth L, Ferrara JV, et al. Clinical and health economic challenges of personalized medicine. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 710-4; https://doi.org/10.1007/s00103-012-1479-2
Renfro LA, An M-W, Mandrekar SJ. Precision oncology: A new era of cancer clinical trials. Cancer Lett 2017; 387: 121-6; https://doi.org/10.1016/j.canlet.2016.03.015
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)