Personalized medicine: how to manage it autonomously?

if they exist Two health ‘keys’ To guarantee a personalized medicine of success throughout Spain, they are Accurate prevention (early disease detection) and molecular diagnosis, But incorporating these technologies is no easy task and the variations between autonomous communities inspire different voices in the region to increase guarantees of their dissemination throughout the region to move towards quality precision medicine. In a discussion organized by medical writing It has been analyzed in collaboration with Roche Pharma Spain What is the plan to promote personalized medicine? With communities running and if they are sufficient, a combination of detection and diagnosis in different tumor approaches or even using Artificial Intelligence tools applied to it can be used.

For carmen duranDirector General of Public Health of the Ministry of Health of the Government of Galicia, Success in the implementation of these plans at the regional level depends There should be a “significant budget” and a common repository of health data For communities to collect all the information: “If we want to take a step forward, let’s do it with a budget. To achieve effective development, it is also essential that we have a common repository of health data, exchange of information or Standard working procedures across all communities“, explain.

federico rojoJiménez Díaz, director of molecular pathology at the Foundation Hospital, explains that these plans are “already late.” “We know it in some areas There are 30 or 40 percent of patients who don’t have access to molecular diagnostics. Or for precision medicine because in that community they do not have the resources to be able to do it, and that is serious,” he explains, in addition to adding the need to articulate a common strategy to achieve this.

Steps forward in personalized medicine

Advances in personalized medicine have been significant. Achieving greater progress in early diagnosis using not only environmental risk factors, but also the individual’s polygenic risk factors may help. Luis Paz-AresThe head of the oncology service at the 12 de Octubre hospital has been asked to make better predictions about “which patients are most at risk.”

“Somehow it’s To make this accurate prevention or early diagnosis universal to a certain extent, I think this is a reality and we have exponentially more knowledge and better technology. It probably won’t be available tomorrow or to all patients, but I think we’ll see major advances in this regard over the next ten years. To do this we need to convincingly demonstrate that these studies do what they should do, lead to early diagnosis and prevention, while also being able to implement population plans that actually integrate what the experimental studies have told us. Does. today we have Examples where early diagnosis is effective and we still don’t do it, As with lung cancer. We have very solid data for more than ten years and we still do not have a clear implementation plan in the country as Europe requests and especially the countries around us,” he admits.

New professional profiles in personalized medicine

Experts have also discussed the increased need to achieve “definite commitment” in all autonomous communities. The development of personalized medicine must go hand in hand Creation of new professional profile That they be included in the health system, as there are currently profiles that are “not included in the health system at this time as well”.

beatriz bellosillo, Head of the Molecular Biology Section of the Pathological Anatomy Service of the Hospital del Mar, This highlights the importance of training personnel to understand the data generated, interpret it appropriately, and deliver it to the end customer, which for us is the physician, who will make decisions for the patient. “This is one of the objectives that I believe is now being worked on from different perspectives, we should plan these profiles within the health sector. Generally most interpretations of the data Requires a profile that has not yet been provided“He analyzes.

Federico Rojo highlights that, today, the possibility of incorporating these specific profiles (molecular biologists and statisticians) into the public health system is not always considered in all communities. “It’s not always possible and many of the people we are training or have trained in this type of technology, who don’t have a regular type of contract within the system, are often working on research projects, sources within research foundations. And I think o too This is a hurdle we must overcome to achieve full implementation“, Add.

AI tools

implementation of tools Artificial intelligence for the development of personalized medicine Some communities are under development. In the Galician case, Carmen Durán has analyzed the use of this AI for breast examinations. “What we do is the mammograms are read in pairs by radiologists and at this time we have added a third phase which will be an AI tool. We start with 35,000 tests and then we will assess whether it is worth continuing. or not with them. But we believe it is an important element to be able Incorporate AI into breast cancer screening” Duran says. In a similar way, they have incorporated colon cancer screening through one tool in all hospitals.

Additionally, Duran points to two more AI projects, one of which is in lung cancer screening, based on a lung cancer risk stratification algorithm. On the other hand, another project at the European level that focuses on prostate cancer screening comes to the fore: “This algorithm also stratifies the risk and aims to ensure that the biopsies performed are as minimal as possible and have different intermediate There are steps. When we are talking about personalized medicine, This medicine will have to go hand in hand with AI for public health Because we need huge databases where we have to expand the results,” he says.

The role of the pharmaceutical industry in personalized medicine

The debate has also left room for, among many other aspects of precision medicine, to be able to know What role does the pharmaceutical industry play? His. Teresa Ramoshead of personalized medicine at Roche Pharma, explains that their “initial mission” will be the development of new innovative treatments for cancer patients, but assures that they have been observing for years that this is “inadequate”: “There are Other unmet medical needs And for some time we have been working on the development of health technologies that come with this arsenal of new treatments. And, above all, we are working in two areas in terms of health technology. First of all, in digital health, which is any information or communication technology that helps us promote better health Or health care for patients,” he admits.

The second pillar in addition to digital health, which Ramos highlighted, relates to the genomic diagnosis of tumors to decide the most effective treatment for each patient, which includes Support professionals and the scientific community in building evidence Essential and measuring outcomes: “What will it mean for me to incorporate this new technology into clinical practice and what impact will it have on health outcomes? Generating this evidence will help us in clinical practice will help accelerate the incorporation of these technologies. We strive to provide the pharmaceutical industry with the tools, technologies and evidence, along with clinical trials that help us understand why we need these How to use the technologies,” he concluded.

Health officials and accurate diagnosis

European countries have made plans for precision medicine and access to molecular diagnostics “For many years” and for Federico Rosso, the model “in the minds of all of us” is France, because it has a network of centers that guarantee all patients access to molecular diagnostics with high-performance techniques. A situation that is not the same as that of Spain, but which believes that something is changing. “In June we had the first Publication of a portfolio of services in genetics and genomics Which includes something that was never written down, which is the diagnosis of somatic changes, within the concept of Precision Medicine prescription drugs, “It is the result of three years of work with a group of experts advising the ministry and representatives of all the autonomous communities,” he admits.

Rojo assured that it has been used to promote and include Biomarkers that are needed for cancer patient diagnosis and treatment in 2023, “This publication includes for the first time a list of tests to which any cancer patient within the national health system should have access and it is now the responsibility of the Autonomous Communities to develop implementation plans and guarantee access to these tests Give. We must not forget that in a decentralized system like ours, beyond the publication by the ministry, each sector has to articulate how to develop and cover that portfolio of services in each community,” he recalls. Although it’s not the same for all of them, Rojo says it’s a first step. “Stepping stone” for precision medicine policy and strategy.,