One size fits all is no longer applicable. Precision medicine has made several advancements in recent years. Rapid development in research and technology is creating conditions for a transformation of the system. With these developments come challenges and consequences – but which ones? And what exactly is accommodated within the concept of precision medicine?  These questions where discussed among 60 participants at a digital round table recently hosted by Vision Zero Cancer and the Confederation of Regional Cancer Centers.

Many precision medicine initiatives are underway. In order to gather the scope of initiatives in Sweden, recapture the state of knowledge and sharpen collaboration, Vision Zero Cancer and the Confederation of Regional Cancer Centers extended invitations to a digital round table. Among the participants were representatives from healthcare, patient associations authorities, industry, academia and other experts.

So what is precision medicine? Precision medicine is about tailoring healthcare for a subgroup of patients. Based on genetics, environment and lifestyle factors, diagnostics, treatments, and decisions can be improved and become more precise. These include molecular biology, genetic sequencing, new imaging techniques, gene therapy, AI, machine learning and data management.

David Gisselsson Nord, MD, PhD, Professor and Specialist Physician, Senior Consultant in molecular pathology in the Southern Healthcare Region, gave examples from the reality of genetic sequencing in childhood cancer.
– Precision diagnostics will be of great benefit to many, says Dr. Gisselsson Nord, but he also points out that sometimes it only works for a certain period of time. We cannot have a static treatment when cancer is ever changing by nature.

Advancements in liquid biopsies, AI, blood tests and national collaborations

Richard Rosenquist Brandell, MD, PhD, Professor of clinical genetics at Karolinska Institutet and Senior Physician at Karolinska University Hospital, gave insights about the Swedish national collaboration Genomic Medicine Sweden (GMS), where he is chairman. GMS coordinates the introduction of precision medicine nationwide, with centers at the seven university hospitals and has launched a national genomics platform to share data across the country.
– We develop standards of how to analyze and interpret, how to work with precision diagnostics and build teams at each center that can use it in treatment. At the same time, it will be a good resource for research and innovation as we can collect the entire country’s data.

AI can improve the operational steps we already have today, rebuild workflows and, not least, do things that we couldn’t do before. Like predicting certain progress. But this also means that new competences in healthcare are needed, such as computer scientists.

Fredrik Enlund, Associate Professor of molecular pathology and head of the Centre for Diagnostics at Region Kalmar, talked about liquid biopsies, a special sampling that can capture the heterogeneity of tumors. That is, genetic clones and mutations within the same tumor.
– Heterogenous tumors are a challenge – which clone is to be primarily treated and what do we do when the patient has received targeted treatment but has developed a clone that can resist the primary treatment? This is where we benefit from liquid biopsies. They can capture that heterogeneity and reduce the risk of resistance if the disease develops. Liquid biopsies can also be used in hard-to-reach tumors to find the right treatment.

The possibilities that comes with AI are great for precision medicine, says Claes Lundström, Adjunct Professor at Linköping University and research director at Sectra. It can save a lot of time for those who work in healthcare and save lives.
– AI can improve the operational steps we already have today, rebuild workflows and, not least, do things that we couldn’t do before. Like predicting certain progress. But this also means that new competences in healthcare are needed, such as computer scientists.

Peter Nygren, MD, PhD, Senior Consultant and Professor of cancer pharmacology at Uppsala University and national coordinator of the MEGALiT project told us about the national cross-sectoral collaboration that under controllable conditions implement new ways of working within oncology.
– We will test tumor response, feasibility and safety of different drugs on different diagnoses, says Dr. Nygren. It paves the way for more advanced use of precision medicine in the next step.

There are certain crossroads in life where you meet healthcare providers. At the childcare center, at school related health services or in screening programs. While being in contact with healthcare, you could easily add taking a blood test to find biomarkers for cancer. Maybe the end goal could even be a simplified blood test to be taken home?

Precision medicine can also make it possible to earlier on detect diseases and find their predispositions. Beatrice Melin, MD, PhD, Senior Consultant and Professor at the Department of Radiation Sciences at Umeå University, pointed out that simple blood tests can provide many answers.
– There are certain crossroads in life where you meet healthcare providers. At the childcare center, at school related health services or in screening programs. While being in contact with healthcare, you could easily add taking a blood test to find biomarkers for cancer. Maybe the end goal could even be a simplified blood test to be taken home?

Authorities investigate the impact and benefits of precision medicine

The roundtable also offered an update from Swedish authorities on their ongoing investigations. Johan Strömblad, Project Manager at the Swedish Agency for Health and Care Services Analysis, talked about the impact of precision medicine on healthcare.
– Achieving the vision requires political priorities, resources to make necessary transitions, patient participation, integration of research and clinical practice, and health data amongst other things. We need to ask questions of how we further cross-sectoral development within knowledge management in the organization, what boundaries are applicable to national highly specialized care and which staff need what knowledge.

As treatments become more individualized for each patient, how do we evaluate the societal benefits of treatment?

Anna Alassaad, Pharmacist, and Project Manager at the Dental and Pharmaceutical Benefits Agency, reported on the health economic assessments for precision medicine – how payment models can be developed to address the high costs of treatment and uncertainties.
– As treatments become more individualized for each patient, how do we evaluate the societal benefits of treatment? This is one of the themes within the analysis. Another theme is value – precision medicine comes with new possibilities, such as earlier risk identification and possible cure. Are values such as these captured in traditional health economic analyses?

Several collaborative projects are developing precision medicine in cancer

Simon Ekman, MD, PhD, Senior Consultant and Associate Professor of oncology at Karolinska University, talked about the Partnership for Precision Medicine in Cancer (PPMC) – an initiative to strengthen Swedish translational research on precision medicine, with coordination of biobanking, clinical data and research data from patients. PPMC is a virtual organization with regional nodes in University hospitals and regional cancer centers.
– We want to achieve better precision in treatments, facilitate follow-ups and find new therapies, says Simon Ekman.

Work at the local level is essential for things to happen on the floor. It’s about building understanding among managers and employees about what precision medicine is. New ways of working are necessary and so is applying new ways of thinking about organization. Academia needs to become a clearer part of healthcare.

Anna Martling, MD, PhD, Professor of Surgery, Senior Consultant at Karolinska University Hospital and Dean of Campus North of Karolinska Institutet, leads the Taskforce for accelerated development of precision medicine. The goal is to accelerate development and coordinate activities within the Stockholm Region by working for implementation in healthcare in order for patients to reap the benefits.
– Work at the local level is essential for things to happen on the floor, Dr. Martling says. It’s about building understanding among managers and employees about what precision medicine is. New ways of working are necessary and so is applying new ways of thinking about organization. Academia needs to become a clearer part of healthcare.

We want to achieve better precision in treatments, facilitate follow-ups and find new therapies

The collaboration program of Health & Life Science is based on the Swedish Life Science strategy. Among other things, it states that Sweden should be a leader in the introduction of precision medicine. Frida Lundmark from The Research based Pharmaceutical Industry is coordinating the government’s liaison group around precision medicine.
– We’re going to act like the glue holding everything together. We won’t identify or initiate our own initiatives, but rather help and highlight the regional initiatives that are underway and further their conditions towards national dissemination and implementation, says Frida Lundmark. We will also structure proposals for the Government Offices of Sweden based on what is already initiated adding extra muscle and speed to enforcement.

Break-out groups provided input for further analysis

The 60 participants were towards the last hour divided into groups to discuss questions about what efforts will be required in the coming years for precision medicine to ensure good, equitable and effective cancer care, as well as which constellations of actors are needed to achieve this. Each group had been appointed a theme to give lead to the discussions, the themes ranged between technology, clinical trials and policy development.

Among the answers where proposals to standardize and coordinate payment models, data sharing and guidelines nationally. Many pointed to the importance of developing competence for existing staff within precision medicine, but also the need to introduce completely new competences and trainings. Several mentioned that the need, value and effects of different therapies, medicines and health economics must be evaluated. The proposals also touched upon increased understanding of the value of investing in research and placing Sweden on the international map.  Further we need to get better at finding and involving patients in order for precision medicine to benefit those intended.

The result of the workshop will be part of the foundation for further work by Vision Zero Cancer and the Confederation of Regional Cancer Centers. It is hoped that these valuable insights can serve as starting points in further analyses and collaborations on various issues.

Thank you to all participants!

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