Why cutting edge drug therapeutics should be paired with multi-omics

But what IS rocket science is developing the tests that make sure those therapies work, and continue to work, when administered to patients!

We do have some pretty good experience with this sort of thing already though.

Technologies such as pharmacogenetic testing have emerged to help predict how patients will respond to certain classes of drugs.

This is done by looking at genetic markers that indicate how quickly someone might metabolize, absorb, or eliminate a drug!

But we also have experience developing ‘companion diagnostics.’

These are diagnostic tests that are used to place patients on a specific therapy.

The first of these was used in 1998!

HercepTest was introduced to identify patients who would respond best to Herceptin, an early antibody treatment for breast cancer.

This test was necessary because Herceptin only worked in patients if their tumors overexpressed the HER2 receptor!

And because of this integration with a biomarker test, Herceptin is often referred to as the poster child for precision medicine!

But we’ve come a long way since Herceptin, and there are some really cool new precision therapeutics on the horizon:

PROteolysis TArgeting Chimeras (PROTACs) - Small molecule drugs that have one end that binds to a target protein and another that binds to E3 Ubiquitin Ligase (a protein that marks other proteins for destruction!)

Antibody Drug Conjugates (ADCs) - These are antibodies that are physically bound to drugs to make their delivery more targeted. The biggest successes here have been in targeting chemotherapy drugs to tumors!

Translation Activating RNAs (taRNAs) - RNA molecules designed to bind to a target RNA to supercharge its translation. This is done by adding a sequence called an Internal Ribosome Entry Site (IRES). These boost ribosome binding on the target RNA and increases production of the target protein.

mRNA Vaccines - We're all familiar with these, but what you might not know is that they can also be quickly programmed to create personalized cancer treatments.

Chimeric Antigen Receptor - T cells and Macrophages (CAR-T/M) - Are immune cells that have been programmed or personalized to seek out and destroy tumor cells.

These are all very exciting, but their development requires a lot of testing to tailor each treatment to an individual.

But what excites me the most in this space is getting the opportunity to move beyond the single biomarker tests of old!

Because seeing the full picture of a patient's response to a therapy through expanded proteomic and metabolomic screening could:

1) Show us how well a drug is working
2) Signal when someone will relapse
3) Mitigate side effects before they're felt
4) Indicate when to change therapies

This is the version of precision medicine that we were promised and I’m hopeful we see these applied more broadly in the clinic soon!