Personalized Medicine – From Theory to Practice


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Personalized Medicine – From Theory to Practice as presented by keynote speaker Ralph Snyderman, MD; Director of the Center for Research on Prospective Health Care, James B. Duke Professor of Medicine, Chancellor Emeritus, Duke University

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  • 10/14/10
  • 10/14/10
  • 10/14/10
  • 10/14/10
  • 10/14/10
  • 10/14/10
  • 10/14/10
  • 10/14/10
  • Personalized Medicine – From Theory to Practice

    1. 1. Personalized Medicine: From Theory to Practice <ul><li>Ralph Snyderman, M.D. </li></ul><ul><li>Chancellor Emeritus </li></ul><ul><li>Duke University </li></ul>©2008 RALPH SNYDERMAN Third Annual Personalized Health Care National Conference at The Ohio State University Advancing Predictive, Preventive, Personalized, and Participatory Medicine October 14, 2010
    2. 2. Science and Medicine 1900s Germ Theory Chemistry Physiology Pathology Physics 2000s Genomics Proteomics Metabolomics Systems Biology Informatics Micro/Nano Processing Find It Fix It Predict It Personalize It Understanding Disease Understanding Health, Disease and Complexity ©2010 RALPH SNYDERMAN
    3. 3. Concepts of Disease Emergence: Multiple factors Reductionism: Single factor Baseline Risk Environmental Factors Preclinical Progression Disease Initiation Disease Progression Irreversible Damage Causative Factor Enhance Health and Well-Being Disease ©2010 RALPH SNYDERMAN
    4. 4. Disease Burden Time Cost 1/reversibility Typical Current Intervention Earliest Clinical Detection Earliest Molecular Detection Baseline Risk Initiating Events Decision Support Tools: Baseline Risk Preclinical Progression Disease Initiation and Progression Assess Risk Refine Assessment Predict/Diagnose Monitor Progression Predict Events Inform Therapeutics Sources of New Biomarkers: <ul><li>Stable Genomics </li></ul><ul><li>SNPs </li></ul><ul><li>Haplotype Mapping </li></ul><ul><li>Gene Sequencing </li></ul><ul><li>Dynamic Testing </li></ul><ul><li>Gene Expression </li></ul><ul><li>Proteomics </li></ul><ul><li>Metabolomics </li></ul><ul><li>Clinical Risk Models </li></ul><ul><li>Clinical Decision Support </li></ul><ul><li>Risk Models </li></ul><ul><li>Theranostics </li></ul>Personalized, Predictive, Prevention ©2010 RALPH SNYDERMAN Personalized Health Planning
    5. 5. Paradigm Shift to Personalization Traditional Medical Evaluation and Record Chief Complaint History of Illness Past Medical History Family History Social History Physical Exam Diagnostic Tests Assessment and Plan Personalized Health Plan Current Health Status Clinical Risk Assessment Tracking Wellness and Pathogenesis Clinical Event Prediction Therapeutic Plans ©2010 RALPH SNYDERMAN
    6. 6. Evolution of Understanding Disease Pre 1850 Pre 1900s Pre 2000 2000s Post 2010 Humoral imbalance Consumption Lung cancer; Stage II a, etc.; treatment by guidelines Lung cancer; Stage II a; oncogenic pathways; advanced guidelines Lung cancer; Stage II a; oncogenic pathways; theranostics; targeted therapies; consideration of associated risks and support systems; personalized Dx, Rx and health plan Metaphysical Phenotypic Phenotypic, refined Mechanistic Personalized, holistic Period Approach Clinical Description ©2010 RALPH SNYDERMAN
    7. 7. Personalizing Care <ul><li>Defining Individualized Clinical Conditions </li></ul><ul><li>Molecular mechanisms Personal setting </li></ul><ul><li>Clinical setting Social setting </li></ul><ul><li>Identification of Risks and Tracking Tools </li></ul><ul><li>Disease-related Therapy-related </li></ul><ul><li>Personalization of Therapeutic Plan </li></ul><ul><li>Theranostics Stress reduction </li></ul><ul><li>Targeted therapies Motivation </li></ul><ul><li>Diet Support groups </li></ul><ul><li>Exercise </li></ul><ul><li>Coordination of Personal Health Plan </li></ul><ul><li>Individual Social setting </li></ul><ul><li>Delivery system </li></ul>©2010 RALPH SNYDERMAN
    8. 8. Personalized Health Care Patient Physician <ul><li>Personal Health Plan </li></ul><ul><li>Risks </li></ul><ul><ul><li>Clinical Condition </li></ul></ul><ul><ul><li>Therapy </li></ul></ul><ul><li>Tracking Tools </li></ul><ul><li>Therapeutic Plan </li></ul><ul><li>Advanced Clinical </li></ul><ul><li>Decision Support </li></ul><ul><li>Practice Guidelines </li></ul><ul><li>Risk Models </li></ul><ul><li>Molecular Diagnostics </li></ul><ul><li>Coordinated Care </li></ul><ul><li>Patient Centered Medical Home </li></ul><ul><li>Accountable Care Organization </li></ul><ul><li>Disease Management </li></ul>Personalized Date Base ©2010 RALPH SNYDERMAN
    9. 9. ©2009 RALPH SNYDERMAN Consider a 28 year old man with a mass in his neck Personalizing Cancer Care
    10. 10. ©2010 RALPH SNYDERMAN
    11. 11. ©2010 RALPH SNYDERMAN
    12. 12. ©2010 RALPH SNYDERMAN
    13. 13. Companion Diagnostics Diagnostic Testing Overview Source: Company websites, L.E.K. analysis ©2010 RALPH SNYDERMAN
    14. 14. Selected Targeted Treatments <ul><li>Gleevec (Novartis) - pH+ CML kinase inhibitor </li></ul><ul><li>Iressa (AstraZeneca) – EGFR tyrosine kinase inhibitor </li></ul><ul><li>Tarceva (Genentech/OSI) – HER1/EGFR inhibitor </li></ul><ul><li>Erbitux (ImClone/BMS) – HER1/EGFR inhibitor </li></ul><ul><li>Avastin (Genentech) – VEGF/VEGFR inhibitor </li></ul><ul><li>Herceptin (Genentech) – HER2 inhibitor </li></ul><ul><li>BilDil (NitroMed) - heart failure in African American patients </li></ul><ul><li>Other “Semi Targeted” Treatments (approved or late stage trials) </li></ul><ul><li>Nexavar (Bayer/Onyx) – multikinase inhibitor </li></ul><ul><li>Tykerb (GSK) - ErbB-2/EGFR inhibitor </li></ul><ul><li>Enzastaurin (Lilly) - PKC-Beta, AKT/P13 inhibitor </li></ul><ul><li>Personalized cancer vaccines (Problematic Development) </li></ul><ul><ul><li>Favrille – FavId for non-Hodgkin's lymphoma </li></ul></ul><ul><ul><li>Genitope – MyVax for non-Hodgkin's lymphoma </li></ul></ul>©2010 RALPH SNYDERMAN
    15. 15. Clinical Decision Support at the Point of Care EHR Clinical Decision Support Clinical Risk Predictors Diagnostics Selectors Therapeutic Predictors Payer Adjudication CPOE New Model Validation Biocausality Engine proventys CDS TM PDx TM ©2010 RALPH SNYDERMAN Personalized Diagnostic and Therapeutic Plan
    16. 16. Pending 510(k) for Proventys PDx Oncology; not available for sale in the United States. Proventys, Inc. 2010 - Business Presentation Only Main risk assessment results page for an individual patient Proventys PDx The FN PDx for febrile neutropenia risk ©2010 RALPH SNYDERMAN
    17. 17. <ul><li>Coordination of Care </li></ul><ul><ul><li>Patient Centered Medical Home </li></ul></ul><ul><ul><li>Accountable Care Organizations </li></ul></ul><ul><ul><li>Disease Management Programs </li></ul></ul><ul><ul><li>Health Care Innovation Zones </li></ul></ul><ul><li>Reimbursement for Performance </li></ul><ul><ul><li>Pay for Performance </li></ul></ul><ul><ul><li>Best Practice Pricing </li></ul></ul><ul><ul><li>Bundled Payments </li></ul></ul><ul><li>Personalized Health Planning </li></ul>PPACA – Elements of Health Care Reform ©2010 RALPH SNYDERMAN
    18. 18. “ It is not the strongest of the species that survives, but rather the one most responsive to change.” Charles Darwin ©2010 RALPH SNYDERMAN