What is Meant By “Personalized” Medicine.
Each patient has a unique set of circumstances and decisions can be made based on the goals of the doctor and patient.
Is the goal to cure the cancer or help the patient live longer and more comfortable.
The doctors at City of Hope will take into account all the individual variables to help plan the best course of treatment for you.
E. Lynn Meyering, M.D is here to answer this and other great questions about “Personalized” Medicine.
Selected Podcast
What is Meant By “Personalized” Medicine
Featured Speaker:
Elizabeth Lynn Meyering, MD
E. Lynn Meyering, M.D., is an Assistant Clinical Professor in the in the Department of Medical Oncology & Therapeutics Research at City of Hope’s Simi Valley location. Dr. Meyering joined City of Hope from North Valley Hematology and Oncology Group, located in Simi Valley, California. Prior to that, she was appointed as faculty at UCLA-Olive View Medical Center as a Assistant Clinical Professor, and she continues her services now as a Volunteer. Dr. Meyering completed her undergraduate degree in microbiology at California State Polytechnic University, and medical school at Albany Medical College in New York. Following medical school, she completed her internship and residency in internal medicine at UCLA-Olive View Medical Center in Sylmar, California. Dr. Meyering is board certified in medical oncology, hematology and internal medicine, and is an accomplished and experienced clinician and teacher. She has a particular interest in breast cancer and survivorship issues. Transcription:
What is Meant By “Personalized” Medicine
Melanie Cole (Host): When you get sick, you want to know that your doctor is helping you and your unique set of circumstances. We are all different and so are our cancers. What is meant by personalized medicine? We’ve heard this term before. My guest today is Dr. Elizabeth Meyering. She’s an oncologist and Assistant Clinical Professor who practices at City of Hope - Simi Valley. Welcome to the show, Dr. Meyering. Tell us about how unique each person is and their cancer. It’s not a one size fits all, is it?
Dr. Elizabeth Meyering (Guest): You know, Melanie, no. It’s not. I think that our notion of personalized medicine has changed a lot over the years. Of course, we are all going to hope that our doctors are going to select treatment for us based on our characteristics. We are not all created equal. As we learn more and more about the human genome and about the genetics of individual cancers, we find that we can actually identify targets that may be more effective and less toxic because we are just targeting cancer cells. So, I think the notion of personalized medicine has changed quite a bit over the past several years but even within that personalized medicine where we are selecting things based on science, there’s still an art, I think, to creating a treatment package which is unique to the particular patient.
Melanie: Dr. Meyering, since tailoring that medical treatment to the individual characteristics or needs of a patient or the certain type of cancer, I understand that everyone is unique and different but you only have a certain number in your arsenal of things that you can do. How do you make it different for each person based on whatever it is that they’ve got going on?
Dr. Meyering: Well, certainly, we have to make decisions on what our goals of the treatment are. If the treatment is curative, then we’re willing to put someone through quite a bit more side effects as opposed to someone where we are just trying to help them live longer, feel better, knowing that we may not cure their cancer. Now, that’s basically trying to select medications with their toxicity levels in mind. When it comes to targeted therapy, that’s actually something where it’s a little bit more elegant and I think that with the targeted therapy that the side effect profiles are so benign--I don’t want to say completely benign, but better. Then, we have more options available and they’re broadening on an ever increasing rate. I can’t even open up a journal today without discovering that there is a new target that we can aim for with these targeted medications. So, certainly, it’s a very complicated notion trying to put together a package. Like I said, the difference is what our goals of the treatment are and also what the family and the patient’s goals are.
Melanie: Do you think, in your opinion, that as personalized medicine becomes more advanced that a pharmagenomics, genomics that these things might happen one day that would be tailored to our genetic makeup? Do you think the pharmaceutical companies are going to be able to, with the help of you oncologists, make drugs and things that are targeted to our specific genetic makeup and whatever cancer we might have?
Dr. Meyering: That is a really good question and I think the answer is “yes”. Maybe not to quite such a simple degree but, for example, we know that women who carry the BRCA mutation can be treated with different groups of medications that are going to have a better chance of having efficacy as opposed to women who are not BRCA mutation carriers. So, I think that that answer is “yes”. The problem, really, is because each individual is unique and different, so are their cancers. So, we have to both target the patient and the cancer. If I could just pause for a moment and say that we are making some dramatic headway with immunotherapy and that is something where we are more targeting the patient. So, I think that the ultimate answer to the question is “yes” and that is probably going to be the big wave of the future and I think going to be one of the wonderful and enormous milestones in American or human medicine, I think.
Melanie: So, in this multi-faceted approach to patient care that is personalized medicine, do you see that this offers the potential to detect the disease earlier? Is there risk assessment, prevention, detection or is personalized medicine mostly geared toward treatment once you’ve developed something?
Dr. Meyering: It’s more geared toward treatment once they have it but I will tell you that people who are known to be carriers of certain genetic abnormalities, certainly, they have heightened screening. Some of the conditions that we are aware of that are significantly related to increased risk of cancer are things like the Lynch Syndrome, which increases GI type cancers, as well as the BRCA mutation, which increases breast and ovarian cancers, among others. Certainly, when people are known to be carrying these mutations, certainly we have heightened surveillance for them. I suppose you could considered that also as part of personalized medicine. Now, whether or not having that knowledge in the future means that we may be able to do things to prevent their cancer, stay tuned. I don’t know that we are there yet but, certainly I think we will be moving that way in the future. I think it’s a little bit of a slippery slope when we start thinking about do we test everybody and then what does insurance do about that? I think we have to be careful not to fall down that slippery slope. Certainly, again, I’ve mentioned it on other segments that nurture and nature is certainly very important. Just because something is there genetically doesn’t mean that it will happen biologically. So, we have to be careful about that. Certainly, though, stay tuned for that.
Melanie: Well, I’m interested that you mentioned insurance companies in this multi-disciplinary approach. Do you think that as you work with various members of your team--that that team together to help the patient receive really the best outcomes--do you think along the lines that the insurance companies will jump onboard for this personalized medicine and see that it will save money in the long run to give this more targeted, personalized care?
Dr. Meyering: I’m hoping so. That is a topic of debate. Certainly, getting insurance or appropriate reimbursement, not only for the medications but also for the testing that may be necessary, is a hurdle that is – I think we are making some headway and certainly they are warming up to the idea because having more targeted therapy means having more efficacious therapy. Certainly treatment with therapies that aren’t working just cost money and does not do anything for the patient. I think that that is an area where there are many people working on but, hopefully, I think that once we have good tests that actually identify meaningful targets, meaning that we have a medication which may be efficacious in that circumstance, if we can sort of marry those together, I think we have a better chance of success. From the insurance company’s standpoint, I do understand because with the escalating healthcare costs these tests are not inexpensive. A lot of times people think, “What is it a couple of hundred dollars?” No, these are in the thousands, typically. So, I understand from their perspective but we do need to really have the bottom line in mind and I’m thinking that they are beginning to come on board with this.
Melanie: In this age of personalized medicine, Dr. Meyering, in just the last minute or so if you would, give your best advice for what you see as the future of personalized medicine and why people should come to City of Hope for their care.
Dr. Meyering: Well, in my opinion, having the resources and the clinical trials available to identify targets, to find out whether or not those targets are able to be appropriately utilized or manipulated, I think that really an academic institution is a good way to go. It’s not for every person but certainly if that is available you want to know about it and you want to be educated about it and you want to be a good consumer and a good advocate for your own health. I think having all of those resources, whether or not you need them at the time, I think is valuable. I would strongly recommend that you learn everything you can about your cancer, should you be diagnosed, to your satisfaction. I do believe that we have the ability to offer all of those specific types of tests and clinical trials that would be helpful should they be needed by the individual.
Melanie: Thank you so much for such great information. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
What is Meant By “Personalized” Medicine
Melanie Cole (Host): When you get sick, you want to know that your doctor is helping you and your unique set of circumstances. We are all different and so are our cancers. What is meant by personalized medicine? We’ve heard this term before. My guest today is Dr. Elizabeth Meyering. She’s an oncologist and Assistant Clinical Professor who practices at City of Hope - Simi Valley. Welcome to the show, Dr. Meyering. Tell us about how unique each person is and their cancer. It’s not a one size fits all, is it?
Dr. Elizabeth Meyering (Guest): You know, Melanie, no. It’s not. I think that our notion of personalized medicine has changed a lot over the years. Of course, we are all going to hope that our doctors are going to select treatment for us based on our characteristics. We are not all created equal. As we learn more and more about the human genome and about the genetics of individual cancers, we find that we can actually identify targets that may be more effective and less toxic because we are just targeting cancer cells. So, I think the notion of personalized medicine has changed quite a bit over the past several years but even within that personalized medicine where we are selecting things based on science, there’s still an art, I think, to creating a treatment package which is unique to the particular patient.
Melanie: Dr. Meyering, since tailoring that medical treatment to the individual characteristics or needs of a patient or the certain type of cancer, I understand that everyone is unique and different but you only have a certain number in your arsenal of things that you can do. How do you make it different for each person based on whatever it is that they’ve got going on?
Dr. Meyering: Well, certainly, we have to make decisions on what our goals of the treatment are. If the treatment is curative, then we’re willing to put someone through quite a bit more side effects as opposed to someone where we are just trying to help them live longer, feel better, knowing that we may not cure their cancer. Now, that’s basically trying to select medications with their toxicity levels in mind. When it comes to targeted therapy, that’s actually something where it’s a little bit more elegant and I think that with the targeted therapy that the side effect profiles are so benign--I don’t want to say completely benign, but better. Then, we have more options available and they’re broadening on an ever increasing rate. I can’t even open up a journal today without discovering that there is a new target that we can aim for with these targeted medications. So, certainly, it’s a very complicated notion trying to put together a package. Like I said, the difference is what our goals of the treatment are and also what the family and the patient’s goals are.
Melanie: Do you think, in your opinion, that as personalized medicine becomes more advanced that a pharmagenomics, genomics that these things might happen one day that would be tailored to our genetic makeup? Do you think the pharmaceutical companies are going to be able to, with the help of you oncologists, make drugs and things that are targeted to our specific genetic makeup and whatever cancer we might have?
Dr. Meyering: That is a really good question and I think the answer is “yes”. Maybe not to quite such a simple degree but, for example, we know that women who carry the BRCA mutation can be treated with different groups of medications that are going to have a better chance of having efficacy as opposed to women who are not BRCA mutation carriers. So, I think that that answer is “yes”. The problem, really, is because each individual is unique and different, so are their cancers. So, we have to both target the patient and the cancer. If I could just pause for a moment and say that we are making some dramatic headway with immunotherapy and that is something where we are more targeting the patient. So, I think that the ultimate answer to the question is “yes” and that is probably going to be the big wave of the future and I think going to be one of the wonderful and enormous milestones in American or human medicine, I think.
Melanie: So, in this multi-faceted approach to patient care that is personalized medicine, do you see that this offers the potential to detect the disease earlier? Is there risk assessment, prevention, detection or is personalized medicine mostly geared toward treatment once you’ve developed something?
Dr. Meyering: It’s more geared toward treatment once they have it but I will tell you that people who are known to be carriers of certain genetic abnormalities, certainly, they have heightened screening. Some of the conditions that we are aware of that are significantly related to increased risk of cancer are things like the Lynch Syndrome, which increases GI type cancers, as well as the BRCA mutation, which increases breast and ovarian cancers, among others. Certainly, when people are known to be carrying these mutations, certainly we have heightened surveillance for them. I suppose you could considered that also as part of personalized medicine. Now, whether or not having that knowledge in the future means that we may be able to do things to prevent their cancer, stay tuned. I don’t know that we are there yet but, certainly I think we will be moving that way in the future. I think it’s a little bit of a slippery slope when we start thinking about do we test everybody and then what does insurance do about that? I think we have to be careful not to fall down that slippery slope. Certainly, again, I’ve mentioned it on other segments that nurture and nature is certainly very important. Just because something is there genetically doesn’t mean that it will happen biologically. So, we have to be careful about that. Certainly, though, stay tuned for that.
Melanie: Well, I’m interested that you mentioned insurance companies in this multi-disciplinary approach. Do you think that as you work with various members of your team--that that team together to help the patient receive really the best outcomes--do you think along the lines that the insurance companies will jump onboard for this personalized medicine and see that it will save money in the long run to give this more targeted, personalized care?
Dr. Meyering: I’m hoping so. That is a topic of debate. Certainly, getting insurance or appropriate reimbursement, not only for the medications but also for the testing that may be necessary, is a hurdle that is – I think we are making some headway and certainly they are warming up to the idea because having more targeted therapy means having more efficacious therapy. Certainly treatment with therapies that aren’t working just cost money and does not do anything for the patient. I think that that is an area where there are many people working on but, hopefully, I think that once we have good tests that actually identify meaningful targets, meaning that we have a medication which may be efficacious in that circumstance, if we can sort of marry those together, I think we have a better chance of success. From the insurance company’s standpoint, I do understand because with the escalating healthcare costs these tests are not inexpensive. A lot of times people think, “What is it a couple of hundred dollars?” No, these are in the thousands, typically. So, I understand from their perspective but we do need to really have the bottom line in mind and I’m thinking that they are beginning to come on board with this.
Melanie: In this age of personalized medicine, Dr. Meyering, in just the last minute or so if you would, give your best advice for what you see as the future of personalized medicine and why people should come to City of Hope for their care.
Dr. Meyering: Well, in my opinion, having the resources and the clinical trials available to identify targets, to find out whether or not those targets are able to be appropriately utilized or manipulated, I think that really an academic institution is a good way to go. It’s not for every person but certainly if that is available you want to know about it and you want to be educated about it and you want to be a good consumer and a good advocate for your own health. I think having all of those resources, whether or not you need them at the time, I think is valuable. I would strongly recommend that you learn everything you can about your cancer, should you be diagnosed, to your satisfaction. I do believe that we have the ability to offer all of those specific types of tests and clinical trials that would be helpful should they be needed by the individual.
Melanie: Thank you so much for such great information. You’re listening to City of Hope Radio. For more information you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.