Michigan Medicine: The health care and technology of tomorrow
Dr. Marschall Runge, MD, PhD
Executive Vice President for Medical Affairs
CEO of Michigan Medicine
Dean of University of Michigan Medical School
Much progress has been made understanding the relationship between specific genetic changes and health, resulting in important opportunities in specific diseases. Research on the complex interface between genes and health is often referred to as Precision Medicine. Now, we know many other factors influence the degree to which genetic changes impact health. Known “disease modifiers” include epigenetics, environmental exposures, societal factors and other influences. Precision Health includes these many disease modifiers for prediction and treatment of complex polygenetic diseases.
Precision Health requires access to and analysis of vast data streams. Many disciplines can collectively have a significant impact on health. Across the University of Michigan campus, over 100 highly ranked departments, centers and institutes provide expertise from discovery research through the entire translational and clinical study spectrum, incorporate new technologies in engineering and computing, collect longitudinal survey data, and study societal factors. Combining this expertise with the resources available through the Joint Institute offers a unique breadth that few other institutions can match.
With access to these vast data comes the challenge is maintaining disciplined focus on select areas. We have chosen to focus on four areas —cancer, mental health, metabolic disease, and opioid use—for our Precision Health. Our partnerships in the Joint Institute will be an extremely valued resources to expand our mutual understanding of Precision Health. The example of opiate misuse and the factors involved span the entire spectrum at our two universities. In the U.S., opiate misuse is now the common cause of death and disability, effecting up to 20% of the population, and is considered a deadly epidemic. If we harness our university-wide and partnership efforts around pain management by developing screening and risk-assessment tools, new prescribing guidelines, and patient education and monitoring, we can impact opioid misuse. The more we can learn about our patients’ propensity to addiction and their particular risk factors, the better we can manage pain, either post-treatment or for chronic conditions.
New Era of Precision Medicine for Head and Neck Cancer
Carol Bradford, MD
Executive Vice Dean for Academic Affairs
Charles J. Krause, MD, Collegiate Professor of Otolaryngology
University of Michigan Medical School
Personalized care of head and neck cancer involves evaluating the complex interplay of biomarkers that may determine the optimal treatment approach for each patient. Biomarkers can be divided into two general categories, patient- and tumor-specific factors. Prognostic markers are informative about disease outcome independent of treatment whereas predictive markers inform response to a particular treatment approach. The goal of a precision approach is to provide individual patients with the most effective treatment that optimizes survival while minimizing the morbidity of treatment.
There is growing awareness of the importance of the immune system in the strategies to cure head and neck cancer. Specifically, overcoming local immunosuppression that is mediated by tumors is a critical strategy that is gaining momentum in various tumor types.
The HPV epidemic has demonstrated that de-escalation of treatment is appropriate in a subset of head and neck tumors with a favorable prognosis. In addition, transoral approaches (transoral robotic surgery or transoral laser microsurgery) provide patients with less morbid surgical options for eradication of primary tumors. With these novel approaches, the primary role of surgery for head and neck cancer has re-emerged.
Intensity modulated radiation therapy, with thoughtful planning of tumor targets, has dramatically reduced the toxicity of radiation treatments with prevention of xerostomia and preservation of swallowing function.
For the first time, The Cancer Genome Atlas (TCGA) analyzed whole genome data for a large cohort of patients with head and neck cancer. These data will define new “druggable targets” in head and neck cancers. Recent published reports note that head and neck cancers are associated with exclusive mutations in CCND1, Fibroblast Growth Factor Receptor 3 (FGFR3), among others. A precision head and neck tumor board is in the planning stages at the University of Michigan whereby all patients will have targeted sequencing to identify potential targeted treatment approaches in the event of tumor relapse.
Thus, it is an exciting time for precision medicine approaches that will define the future of care for our patients with head and neck cancers.