U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Translational Sciences, Office of Clinical Pharmacology, Silver Spring, Maryland, USA.
Mila's Miracle Foundation, Boulder, Colorado, USA.
Clin Pharmacol Ther. 2023 Nov;114(5):994-1001. doi: 10.1002/cpt.3030. Epub 2023 Sep 13.
Precision medicine has evolved from the application of pharmacogenetic biomarkers to the prospective development of targeted therapies in patients with specific molecular/genetic subtypes of disease to truly "N-of-1" medicines targeted to very small numbers of patients - in some cases, a single identified patient. This latter iteration of precision medicine presents unprecedented opportunities for patients with severe, life-threatening, or life-limiting diseases. At the same time, these modalities present complex scientific, clinical, and regulatory challenges. To realize the promise of individualized medicines, a multistakeholder approach to streamlining medical diagnoses, advancing the technologies that enable development of these therapeutic modalities, and re-envisioning collaborative environments for access and evidence generation is of critical importance. Herein, we highlight some of these challenges and opportunities.
精准医学已经从应用药物遗传学生物标志物发展到针对特定分子/遗传疾病亚型的靶向治疗的前瞻性开发,真正实现了针对极少数患者——在某些情况下,是单个确定患者的“N-of-1”药物。精准医学的后一种迭代为患有严重、危及生命或生命有限的疾病的患者带来了前所未有的机会。与此同时,这些模式也带来了复杂的科学、临床和监管挑战。为了实现个体化药物的承诺,需要采取多方利益相关者的方法来简化医疗诊断,推进使这些治疗模式得以发展的技术,并重新构想获取和证据生成的协作环境,这至关重要。在此,我们重点介绍其中的一些挑战和机遇。