A Message on Precision Medicine at Penn

January 30, 2015

Dear Penn Medicine Faculty, Students and Staff,

In his recent State of the Union address, President Obama announced that he intends to launch a new “Precision Medicine Initiative,” providing a timely opportunity to report on where we stand in this domain and where we are headed.

Our faculty recognized this topic as one of the key pillars of the Penn Medicine Strategic Plan in 2012. Indeed, our planning group stated, “The future clinical environment will be characterized by rapid and precise individualized diagnosis and treatment. Better integration of our clinical operation with our academic research enterprise will give us a competitive advantage in the marketplace of academic medical centers.” This effort was formally launched with the recruitment of Gary Gilliland in 2013. While Gary has recently assumed a new leadership role as President of Fred Hutchinson Cancer Center, we are deeply grateful for the inspiration and vision he provided as we began our Precision Medicine initiative. We are pleased to announce that David Roth, working closely with a group of other senior leaders at Penn Medicine, will continue this project’s momentum.

At Penn Medicine, we launched the Center for Personalized Diagnostics (CPD) in February 2013 with an initial focus on cancer mutations with treatment implications. David Roth and his colleagues in Pathology and Laboratory Medicine have ushered this new program through a development and regulatory approval process. It is already affecting clinical care for our patients. Kojo Elenitoba-Johnson, an accomplished hematopathologist and molecular pathologist at the University of Michigan, will soon be joining us to lead the CPD.

For reasons summarized below, Precision Medicine remains one of our highest institutional priorities. Ultimately, one of the great differentiators of Penn Medicine is our ability to provide advanced clinical care by making refined and accurate diagnoses, allowing optimal treatment choices based on this information.

The growing recognition of Precision Medicine by policy makers, as well as patients and clinicians, is a welcome development and a real opportunity for Penn Medicine, but the concept itself is not new. Diagnostic accuracy has always been a cornerstone of medicine. We now take for granted that bacterial infections are diagnosed based on identification of the causative organism. Treatment is then based on assessment of antibiotic sensitivities – this is Precision Medicine. What is new is that our diagnostic tools are rapidly expanding the scope of Precision Medicine. In particular, advances in genetics, genomics, imaging, cell sorting, proteomics, and other diagnostic fields are resulting in new classifications of disease, often with important prognostic and treatment implications. In short, the field has matured to the point that it is poised to impact clinical care, and in many instances, reduce costs while improving outcomes.

Precision Medicine will undoubtedly continue to have a major impact in cancer, particularly with the advent of targeted therapies (Precision Therapeutics) based upon specific mutations and altered pathways (e.g., BRAF, ALK). We can anticipate that clinical trials will increasingly be designed based on this type of stratification. However, the concept of Precision Medicine applies to virtually every medical field, and we need to be creative in our conceptualization of its impact. For example, most diagnostic algorithms for common conditions, such as chest pain or thyroid nodules, could be considered Precision Medicine. For this reason, a number of other initiatives in our Strategic Plan complement and leverage Precision Medicine. Examples include the new Institute for Biomedical Informatics, to be led by Jason Moore, the new Biobank directed by Dan Rader and Michael Feldman, and a redirected focus of the Department of Systems Pharmacology and Translational Therapeutics, chaired by Garret FitzGerald. Perhaps less obvious but also relevant is our ongoing effort to coordinate clinical care around disease areas (e.g., Cardiovascular, Cancer, Neuroscience, Musculoskeletal) by bringing together the skills of faculty in multiple departments. This approach positions us well to effectively implement principles of Precision Medicine in the clinical setting.

Where Precision Medicine will lead remains to be seen, but we are optimistic. Whether it goes by the name of personalized, individualized, or precision medicine, the concept is a path to innovation. In recent weeks, a team led by Caryn Lerman found that slow or fast metabolizers of nicotine respond differently to varenicline treatment. This is one of many examples of using pharmacogenomics to tailor treatment as a means to achieve greater efficacy and avoid unwanted side effects among non-responders. In addition to the direct benefits of this more specific treatment, the health benefits of more effective smoking cessation could be profound. As a practical matter, Precision Medicine must add value to the quality of care for patients, and in many instances, it can reduce costs providing an incentive for reimbursement.

As President Obama reminded us, we are on the cusp of a new era of medicine that delivers the “right treatment at the right time.” Penn Medicine is ideally poised to shape this healthier future for our nation and the world. As one faculty member recently put it to us, “With our infrastructure, we have a great opportunity to lead by strategically approaching precision medicine. We need to use our extraordinary analytic strength to continue to distinguish ourselves.” And we will.

With best regards,

&quote;Larry&quote; Signature
J. Larry Jameson, MD, PhD