Medicine by design

May 25, 2015

The future of health will focus on the individual, and benefit from more integration between the patient, clinician and researcher.

IT’S 2040. Jane taps her foot nervously, waiting for her smart watch to link to her oncologist via video. Her cancer-screening blood test (routine at age 45) has found circulating tumour cells. Jane is about to find out what type of cancer she has and what her next steps will be.

Her watch beeps, but it’s not the oncologist. Her health app bursts onto the screen telling her she’s been sitting for too long. Time to get up and move for five minutes… Does she want to listen to dance music? Jane’s not in the mood, but she gets up and paces the room.

Miranda, the oncologist, has most of her patient consultations via online telehealth video conferencing. Her first step following Jane’s blood screen result was to download her patient’s genome. Then she ran a computer program to compare Jane’s genome with the set of blood test results that showed she has breast cancer; revealing its type and the cancer cells’ DNA sequence.

Using data from hundreds of thousands of breast cancer cases worldwide, the program helps Miranda devise an optimised treatment program for Jane. She presses the button to begin the consultation.

Miranda breaks the news gently. Cancer is a worry, of course, she says. But things are so much better than they were 25 years ago. She is confident the imaging will find a tiny primary tumour, which can be removed – in a surgical procedure known as a lumpectomy – and then Jane will have drug therapy for several years, with few side effects, to dramatically reduce the chance of the cancer spreading (metastasising).

Most people beat breast cancer nowadays and there is usually no need for chemotherapy, Miranda reassures her.

“One in two of us will get cancer and one in five of us will die from cancer. One of the challenges at the moment is what’s called ‘treating the undetectable’.”

Science fiction? Yes. But it certainly may become science fact, according to Dr Warwick Tong, CEO of the Cancer Therapeutics CRC (CTx), and Professor Bob Cowan, Chief Executive Officer of the HEARing CRC.

Mopping up cancer

In Tong’s view, blood tests – or ‘liquid biopsies’ – to screen for all types of cancers will become routine. The basic technology already exists, at least for colorectal cancer, he explains.

Tong is spearheading a new approach to cancer drug therapy. While most chemotherapy drugs shrink secondary tumours that result from metastasis, CTx is working on ‘mopping up’ cells that migrate from the original tumour at a very early stage.

“One in two of us will get cancer and one in five of us will die from cancer – and 90% of those deaths are caused by vast metastatic spread,” he says. “One of the challenges at the moment is
what’s called ‘treating the undetectable’. We treat primary cancer pretty well nowadays, but often the disease reoccurs years down the track.”

Drugs used in early stage cancer, alongside treatment of the primary tumour, are called ‘adjuvant’ therapies. But, Tong explains, few pharmaceutical companies are exploring adjuvants because the research is expensive and it’s difficult to prove they work. In fact, most of the few existing adjuvants – such as the drug tamoxifen, which is used for breast cancer – were developed for late cancer and have become adjuvants through chance rather than design.

“The focus of our drug discovery program is ‘adjuvant by design’”, says Tong. And it is work like this at the CTx that may lead to 2040 drugs, similar to those Jane will use.

Treating the individual

Jane’s individual treatment protocol will typify 2040 medicine, explains Cowan. “Up to now, evidence-based medicine has been founded on group analysis. But in 2040, instead of applying group statistics to an individual, we’ll be able to understand their particular risk and make treatments more personal.”

At the heart of this lies our ability to sequence a person’s DNA, which can now be done for just a few hundred dollars.

Cowan predicts that the accumulating digital information on individuals will create a “data storm” and, ironically, as individualised treatment becomes the norm, the data available for group analyses will also massively increase. “So there may be factors we have been unable to identify because of variation in the environment and gene expression, which will become clear when we start to get much larger samples,” he explains.

Drawing on his experience in hearing, Cowan foresees major advances in prosthetics. The hugely successful cochlear implant, developed in conjunction with HEARing CRC, is a prosthetic – the union of an artificial device with the human brain. “Australia leads the world in cochlear implants,” he says.

Sadly, one of the major drivers for prosthetics is war. The ravages of landmines and improvised explosive devices have brought increased funding for the development of better prosthetic limbs. The aim now is to marry the prosthetic more intimately with the individual’s own nervous system: something that requires new approaches for regenerating nerve connections.

Cowan’s vision for prosthetics is exciting: “You’ll simply think ‘pick up
the glass’ and your prosthetic arm will execute all the necessary movements as your own arm did in the past.”

creening computational specialist Rebecca Moss at the Cancer Therapeutics CRC  High Throughput Chemical Screening Lab.
Screening computational specialist Rebecca Moss at the Cancer Therapeutics CRC High Throughput Chemical Screening Lab.

Cost-effective medicine

Forecasts for 2040 predict that the
human population will include twice as many people aged 65 or over, which is concerning to Cowan because it means that a greater proportion of people will have problems with hearing and cognition.

“More and more we are going to see the need for reducing the strain
on the health system,” he says, adding that telehealth will be a very important aspect of this. “We need to deliver systems through our broadband network.” Treating more people at home, under medical supervision, rather than in hospital, is the way ahead, he says.

“We need to change the way that we do diagnosis, and involve the individual in managing their own health,” Cowan says, explaining that the technology is already here and it’s the healthcare delivery system that needs to change. “We have technology now that allows us to have a clinician based in Sydney programming a cochlear implant for a child in Samoa.”

The successful translation of Australian research into practice will be vital. “Australian basic medical research is excellent,” Cowan says. “We punch above our weight internationally. But, unless we take knowledge gained from research and translate it into a clinical application, it doesn’t make an economic return for Australia.

“To do that you need to involve clinicians from day one, which is exactly the approach of the medical CRCs.”

Clare Pain

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