The rapidly evolving field of personalised medicine is being realised, thanks to advances in clinical genetics and new therapeutics. Dr Jean-Frédéric Levesque reveals how this is transforming healthcare for better patient outcomes.
Personalised medicine (also known as precision medicine) is at the forefront of scientific and technological advancements in patient-centred healthcare.
We now understand a lot more about the human genome and the association between genetic variation and disease. This is accelerating personalised approaches to medicine as new genomic tests open avenues for disease diagnosis, prognosis and treatment.
We can increasingly tailor what patients need, according to their own genetic background. For example, we can find genes through pre-natal screening that can inform a person’s early health intervention and targeted treatment throughout their life.
This can have exponential benefits for the individual, their families and carers, and the health system.
Personalised treatments
The Agency for Clinical Innovation (ACI) plays a key role in progressing clinical implementation of personalised treatment approaches and transforming the health system to use them in an effective way.
Our Blood and Marrow Transplant + Cellular Therapies Network is working with clinicians and key partners to introduce immune effector cell (IEC) treatment for people with some blood diseases, such as cancer.
This cutting-edge therapy uses an individual’s own immune effector cells to target and treat their disease. This is very different from the way we used to think about evidence-based care – we would look at a population and the bigger impact of treatments overall. This meant some people would not benefit from population-based treatments if they had a stronger interaction with the disease.
The ACI works with the Ministry of Health, the Cancer Institute NSW, local health districts and clinicians to progress implementation of IEC therapies into clinical practice and build capability across the system. We are supporting centres to become accredited and ensure they have the appropriate technology, procedures and skills in place, as well as develop patient information resources.
This is a rapidly evolving area; with an increasing number of conditions that IEC treatment can be used for. This is very promising for those who don’t respond to traditional therapies.
Embedding genetics into clinical care
On a broader scale, genomics is influencing personalised medicine across diverse clinical areas. It is delivering better diagnostic and screening programs that enable us to:
- identify and profile the population with rare or previously undiagnosed conditions
- understand the risk for a specific person and their families
- identify and, where possible, deliver treatment that is tailored to a specific genetic condition.
Importantly, it requires stakeholders at all levels, and across disciplines, to work together to ensure safe and optimal care in this fast-moving area.
The ACI’s Clinical Genetics Network works to connect different clinical areas and embed genetics into mainstream care. This involves streamlining processes and developing pathways, so clinicians know how they can involve genetics in their clinical practice.
There are strong ethical dimensions to consider, as well as the need for education and capability building to ensure appropriate referrals to genetic services.
Last year, the ACI worked with clinicians and key stakeholders to develop the Clinical genomics model of care. The model identifies four clinical priority areas to ensure patients receive the right services at the right time:
- access
- timeliness
- optimising health
- ongoing care.
A toolkit is also available to support implementation of the model within clinical genomics services.
Our network is also involved with research groups and provides advice to the Health Education Training Institute to develop education tools and resources for non-genetic clinicians.
At all levels and across the system, we are working towards the NSW Genomics Strategy, that outlines a shared vision for genomics in NSW. It describes pathways to implementation and makes recommendations on how NSW can remain responsive to this transformation in healthcare.
This is an exciting and transformative time in healthcare.
Please read more about this in our guest editorial by our Clinical Genetics Network Co-Chairs, Dr Lisa Worgan, Clinical Geneticist and Bronwyn Burgess, Genetic Counsellor.