Square peg, square hole — Unleashing the potential of genomics and personalised therapies
The promise of precision medicine — tailoring treatments to an individual’s unique genetic and molecular profile — has long been heralded as the future of healthcare. However, as industry experts discussed at a recent panel, significant challenges remain in scaling personalised therapies and making them accessible to patients who need them most.
The panel, which included leaders from biotech, pharmaceuticals, venture capital, and healthcare technology, highlighted several key obstacles facing the precision medicine field today:
Scaling Production and Access
Jason Foster, CEO of cell therapy company Ori Biotech, emphasised the difficulty of manufacturing personalised therapies at scale: “We have incredibly clinically effective products — we have effective cures for cancer today — that for the most part patients can’t get access to. And the reason is that they’re very hard to make. They’re generally very expensive because they are hard to make, and we just can’t make enough of those products.”
Foster noted that it costs pharmaceutical companies nearly $2 billion to bring personalised medicine to market, with only a 7% success rate for products entering clinical trials. This creates a major challenge in making the economics work.
Dana Mendenhall, Global Commercial and Portfolio Strategy Lead at Takeda Pharmaceuticals, echoed this concern from the pharmaceutical perspective: “The very thing that we are trying to do to personalise medicine, in some ways, is running into conflict with the historical ways of working, the ways that we’re approving medicine.”
She explained that regulatory bodies are focused on approving drugs that can treat large patient populations, which contradicts the personalised approach. However, Mendenhall noted that patients are becoming more empowered and “demanding that these things happen in personalised medicine.”
Reimbursement and Value-Based Care Models
A key challenge discussed was making personalised therapies economically viable within existing healthcare systems. Ben Zenziello, Chief Medical Officer of Best Buy Health, expressed scepticism about value-based care models solving this problem:
“Value based care has become a little bit of a trigger expression to me. It’s like something deep in the horizon keeps receding…we’re not speeding up we’re actually kind of slowing down.”
He cited hepatitis C treatments as a potential model, where costs have decreased over time as more competitors entered the market. However, Zenziello noted this process took nearly ten years.
Managing Director of Foresite Capital, Vikram Bajaj emphasised that generating clinical evidence for personalised therapies is inherently time-consuming: “We talk a lot about data, but ultimately, it’s not about the data. It’s about evidence, and generating evidence of almost anything in healthcare takes a long time. That’s why our product cycles are decades or more.”
Foster argued that fundamentally, the issue comes down to risk-sharing between therapy developers and payers: “If I’m a payer, and I pay for something, I want to get the value that I’m paying for. If I’m a developer, developing a product at risk, I should have the expectation that I’m going to get some of the value back if my product delivers…The problem is that’s not true today, there’s a mismatch between risk and expectation between developers and payers.”
He suggested that providing more certainty around reimbursement for therapies meeting certain efficacy and economic profiles could help incentivise the development of personalised medicines.
Funding Innovation
Despite these challenges, the panellists saw a continued appetite for investment in precision medicine approaches, particularly in oncology, where there is a track record of success.
Bajaj noted: “Products like oncology products that are deployed in small groups where you have a strong expectation that the efficacy is high and there’s aftermarket — there’s actually capital that flows to those very, very freely. Because there’s 20 years of examples that work at this point.”
However, he acknowledged that funding is not as readily available for precision approaches in other disease areas or for more radically personalised therapies.
Foster emphasised that for health tech innovations as well, “there has to be a very clear commercial proposition alongside the clinical safety proposition.”
Diversity and Inclusion
The panellists highlighted the importance of diversity and inclusion in advancing precision medicine. Mendenhall explained that pharmaceutical companies are increasingly focused on diversifying clinical trials:
“How do we diversify our clinical trials? How do we diversify inclusion about patients insights and not just from an ethnicity standpoint, from a geography standpoint, from an economic standpoint…the more we get into personalised medicine, the more critical this becomes.”
Bajaj added that diverse trial enrollment is scientifically crucial: “The more we personalise therapies, especially based on molecular genetic other measures, it’s very obvious that we have to enrol a diverse population that represents the intended population in which the therapeutic will be deployed because these diseases are very heterogeneous and those subgroups differ by race, and other factors.”
Zenziello noted that addressing diversity in precision medicine ties into broader health equity issues: “We’re at the beginning of this health equity journey…we’re just starting to touch on aspects of the access issue, just getting access to care in general, whether it’s a hospital or primary care.”
Looking Ahead
Despite the significant hurdles, the panellists remained optimistic about the long-term potential of precision medicine to transform healthcare.
Foster predicted that the ability to tailor treatments based on patient data for cell therapies is “not 20 years away. That’s probably seven to 10 years away when you have enough of those kinds of data.”
Mendenhall emphasized that patients will continue driving progress: “We are becoming smarter; patients are becoming smarter. They are advocating more for themselves and demanding that these things happen.”
Ultimately, realising the full promise of precision medicine will require continued innovation not just in science and technology but in healthcare delivery models, reimbursement approaches, and regulatory frameworks. By bringing together stakeholders from across the healthcare ecosystem to tackle these challenges collaboratively, there is hope that personalised therapies can become accessible realities for more patients in need.
