Weighing Precision Medicine's Promise, Pitfalls

The October event at the Harvey Morse Conference Center featured three guest speakers plus leaders of research projects funded by Cedars-Sinai Precision Health, a partnership among scientists, clinicians, industry and patients. Since its launch in 2016, the partnership has allocated more than $2 million to 21 projects across the institution. The deadline to apply for the latest round of funding is Nov. 27.

In a discussion panel involving three experts, Raju Kucherlapati, PhD, Paul C. Cabot Professor of Genetics at Harvard Medical School in Boston, said many people view ours as "a golden age in genetics." He described three revolutions behind that perception:

• The realization that nearly all diseases have a genetic basis, as revealed by data from studies of siblings. This data indicates, for instance, that if one identical twin has diabetes or obesity, the other twin may have a 90% chance of developing these conditions.
• The completion of the Human Genome Project in 2001-03. This international program created a genetic blueprint of the genes that define the human species and make each of us unique.
• The development of precision medicine, which uses genetic data to improve human health by directing the diagnosis, prognosis and therapies for diseases.

Kucherlapati said Cedars-Sinai is a beacon of precision medicine to the world. In an interview afterward, he praised the leaders of Cedars-Sinai Precision Health for reaching out to all the institution's departments to leverage their expertise in pathology, molecular genetics and other disciplines.

The panel's second speaker, Ysabel Duron, discussed the challenges of bringing precision medicine to diverse populations. Duron is founder and director of the Latino Cancer Institute, a nonprofit based in San Jose, California, dedicated to promoting cancer education and services to Latinos.

"Precision medicine needs to address the disparities in low-income, underserved communities," Duron said. She noted that in places such as Monterey County, California, nearly one in five Latinos lacks health insurance, a major barrier to accessing the latest treatments. A good way to reach this group is through community health workers, who can be deployed like a "mini-army" to educate community members about their healthcare options, Duron suggested.

The third panelist was Michael Pellini, MD, MBA, managing partner of Section 32 LLC, a California-based venture capital fund for healthcare technology. He addressed another barrier to getting cutting-edge treatments to patients: the lengthy, uncertain process of delivering new drugs into the marketplace.

For all the effort expended to create and refine new treatments at academic institutions, Pellini said, "We hardly ever address how precision medicine technology will be used in routine medical care." That is a critical question because about 80% of cancer patients are treated in the communities where they live, not at major cancer centers. Companies that do a good job of moving drugs into clinical use can be very successful, he said.

After the panel, breakout sessions allowed Cedars-Sinai investigators to present 12 research studies that have received grants from Cedars-Sinai Precision Health. "We are very encouraged by the diversity of the projects we have funded," said Dermot McGovern, MD, PhD, FRCP(Lon), who directs the initiative. McGovern also is director of Translational Medicine in the Cedars-Sinai F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute and professor of Medicine and Biomedical Sciences.

Topics of the studies presented at the breakout sessions included ovarian cancer, inflammatory bowel disease, the undiagnosed patient and prediction of childhood outcomes based on neonatal variables, among others.