Not Knowing the Knowable
One of the most tragic causes of cancer mortality
Today, two people receiving world-class care in different parts of the world, both suffering from a known and identifiable cancer, may experience two very different outcomes. One person will succumb to a cancer for which the other has been successfully treated. Unfortunately, this divergent path often remains a tragedy of modern medicine, made even worse since this disparity may often be solvable, the information to do so is at hand, and it is becoming widely available to all.
Let’s start with a question: what do we know? Recent breakthroughs in our understanding of cancer, broadly speaking, have been astonishing. First, we now know that the location of cancer in the body is not necessarily the complete, or even the most useful, data point in a physician’s selection of a course of therapy. We’ve learned that cancer can be categorized by the underlying alterations in the tumor’s DNA and RNA that drive its growth. For example, the cause of lung cancer in one person can be entirely different as that in another patient with lung cancer. These new and critical understandings of the tumor’s molecular makeup can lead to individualized treatments and targeted therapies, personalized care in cancer, and much improved outcomes. Worldwide healthcare, technology, educational, and financial contributions have brought us to this place, a new beginning in cancer care.
This knowledge is starting to revolutionize the way medicine is practiced and is most vividly seen today in the diagnosis and treatment of patients with cancer. However, where we have yet to go next may prove the most useful and transformational development in medicine to date.
Our rapidly evolving understanding of the underlying causes of cancer has exposed the need for a new way to approach the explosion of data as the clinical decisions will be derived from such information. One can envision the significant utility of a technology-driven, worldwide “knowledgebase” standard complete with globally contributed molecular data detailing the ongoing discoveries of genomic alterations that trigger cancers and other pathologies. This borderless, real-time knowledge platform would inform any medical practitioner regardless of the location of the diagnostic, treatment and outcome results of any other healer anywhere in the world facing similar or related challenges.
For centuries, cancer has been a treacherous keeper of hidden secrets, but these secrets are now being revealed in greater number, at a faster pace, and with more promising implications than ever. If we are slow to share the secrets using the available technologies for knowledgebase building and data mining, cancer will prevail. In brief, by systematically gathering, building, and sharing data, we can put an end to the modern tale of two cities, two patients, and two markedly different outcomes in which the best and worst of times may be left to the coincidence or happenstance of where one lives and gets treatment. In contrast, a global, living, working, and ever-expanding knowledgebase can mean every patient experience anywhere will inform the treatment of all others; the knowledgebase will grow; and the aggregate data will increase in value as it is fathomed, analyzed, synthesized and shared by others.
This knowledge platform would at long last, among other things, share complete and usefully compiled information derived from pharmaceutical trials, while informing healthcare professionals everywhere of potential opportunities for patient participation. It would also likely accelerate regulators’ and payors’ understanding that a drug approved for a specific use can have specific benefits in other clinical indications where there are similar genomic alterations. It would revolutionize the way medical education is taught with a shift in focus from rote memorization to mastering the art of search and analysis of relevant, timely information. Medical knowledge and practice would move swiftly to become even more collaborative, contributive, and cooperative, aided by an information and discovery platform at its epicenter now made exponentially more powerful with the use of information age tools.
Any death from cancer is often a source of tremendous grief, but it may be additionally tinged with anguish if it is learned the patient may have been treated successfully if only more of the world’s available medical and scientific information had been made known and accessible.
This shared and updated knowledge platform is a necessary vision for the future. Patients and doctors will transcend many of the labels still applied to various cancers, such as terms that identify the illness on the basis of its bodily geography. We will expand our ability to catalogue a growing number of cancers based on their unique genomic anomalies. We will treat the genomic changes at the molecular level aided by the availability to both patients and doctors of an exhaustive and up-to-the-minute knowledgebase of information that can be probed for related cases, successful treatment therapies, and relevant pharmaceutical trials. If we do this well, the prognosis for outstanding outcomes improves even more dramatically. The traditional, all-important one-on-one doctor-patient relationship becomes a thousand-to-one doctors and patients in a global collaborative, comparative effort to identify, analyze, and treat the individual.
Dr. Michael Pellini is president and CEO of Foundation Medicine. Pellini received a BA from Boston College, an MBA from Drexel University and an MD from Jefferson Medical College of Thomas Jefferson University. He is a board member of the Personalized Medicine Coalition and serves on the President’s Leadership Council of Jefferson Medical College.
The World Economic Forum’s Annual Meeting 2015 will take place from 21–24 January in Davos-Klosters, Switzerland, under the theme “The New Global Context.” You can find out more about the meeting here.