Boston, MA-In the keynote lecture at the recent Palliative Care in Oncology Symposium, Howard L. McLeod, PharmD, discussed advances in personalized medicine as they relate to palliative care, as well as the challenges that remain within the realm of cancer care.
"The whole field of palliative care is personalized medicine," said Dr McLeod. "You're looking at patient attributes, and trying to understand how to intervene in order to help patients derive the best quality from their remaining years, months, or whatever it might be going forward."
Though he acknowledges that progress in the field is ongoing, oncology has a long way to go before personalized medicine becomes a reality for every patient.
Multiple active regimens now exist for the treatment of most cancers. However, with this choice comes variation in response to therapy and unpredictable toxicity.
"The clinical problem around therapeutics is quite a wonderful problem," said Dr McLeod, medical director of the DeBartolo Family Personalized Medicine Institute at Moffitt Cancer Center in Tampa, FL. "There are now multiple treatment options for almost anything you're trying to do, which means there are some real decisions to be made."
"There is still a great variation in response to therapy," he said. "Many patients do not respond to certain therapies or do not have durable responses, much less curative responses, even with modern approaches to which others respond well."
Dr McLeod also elaborated on the issues of toxicity and cost. "Acceptability needs to be defined by the patient, not the prescriber," he said. "Patient-derived outcomes are going to be a key part of this, because what's acceptable to me is not necessarily acceptable to the patient we're trying to care for."
"The idea that toxicity matters is a big deal," he added. "Grade 1 toxicity matters."
"Adverse drug reactions are also a big deal in this country," Dr McLeod emphasized. Not only are adverse effects important to the patient, they also constitute a heavily litigated area. With new technology, many of these reactions are predictable.
Sadly, adverse drug events are the fifth-leading cause of death in the United States.
Addressing cost, he noted that while cancer chemotherapy is expensive, physicians are seeing more opportunities to improve value for the patient through more precisely tailored therapies. "We're now seeing real opportunities to make sure patients are getting the best options for them, not just for us and our health system," he said.
Despite advances in precision medicine, prescribers still lack the means to use DNA-based markers to identify which patients will benefit, which will experience excess toxicity, which require dose adjustment, and which will have heightened sensitivity to a given agent. "There's still a need for discovery," he emphasized.
Dr McLeod stressed the importance of further research in building on personalized medicine. "The concept of trying to separate out toxicity, efficacy, and other elements is one that we can build on. And we can only build on it if we have the robust data sets with which to go forward."
"What needs to be done to determine hope versus hype?" he asked. "Find the 'right' biomarkers, validate them in robust data sets, and then apply them."
He added that patients should be able to make wise decisions that fit their values and desires, and that they should be able to learn from similar patients, "as opposed to this idea that they're one of a kind."
Finally, Dr McLeod emphasized the importance of considering both benefit and risk in making preemptive assessments. Complex data need to be presented in a manner that helps patients and clinicians, working together, to make informed decisions.
"If we're going to make advances in patient care, we have to think about what the patient is suffering from and how we can help them," he said.
McLeod HL. Keynote lecture: the role of biomarkers in palliative care-predecting toxicity, maintaining quality of life. Presented at: 2015 Palliative Care in Oncology Symposium; October 9-10, 2015; Boston, MA.