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Road To Personalized Medication

Personalized medicine is the tailoring of medical treatment to the individual characteristics of each patient. Knowledge of a patient's genetic profile assists doctors select the proper medication and administer it using specific dosage, creating an overall customized treatment.

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Personalized medicine has the potential to evolve the configuration and management health issues. It has already had an exciting impact on both patient care and clinical research during medical trials. This impact will see an upward rising trend as our understanding of medicine deepens and technology further develops.

Dr AK Gadpayle, Professor and Senior Consultant, Internal Medicine Department, Sharda Hospital explains, “Tailoring of medical treatment of each patient is becoming more common because of advancement in medical technology. This individualised approach has a potential to improve overall care, surgical outcome and treatment of diseases like COVID-19. The other examples like Breast Cancer where genomic and unique molecular response with Herceptin, Gleevec in Chronic Myeloid Leukemia and other oncological condition. Even in case of cystic fibrosis this treatment has become helpful.”

Impacting patient care in many diseases

Cancer: The most common examples of personalized medicine came in trastuzumab. Trastuzumab was approved for patients with HER2 positive tumors in 1998 and further research in 2005 revealed that it lowers recurrence by 52 per cent in combination with chemotherapy.

Dr Ullas Batra, Sr Consultant & Chief of Thoracic Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), Delhi informs, “Personalised medicine is the new frontier in cancer care. In fact, cancer treatment has changed dramatically in the last decade with the emergence of an era of personalised medicine. For instance, in case of lung cancer, which is one of the most common cancers in India, new treatment options are available that are more precise and customized according to subtype and molecular profile of lung cancer. Over the last few years, molecular targeted therapy has caused a paradigm shift, with a better safety profile, fewer side effects and better survival outcomes for the patients.”

Melanoma: BRAF is a human gene responsible for the formation of a protein called B-Raf, which is involved in transmitting signals inside cells to direct cell growth and shown to be mutated in cancers. In 2011, a drug called vemurafenib, a B-Raf protein inhibitor and the companion BRAF V600E Mutation Test were approved for the treatment of late stage Melanoma.

Cardiovascular diseases: Previously, the primary method for managing heart transplant rejection was the invasive technique of endomyocardial biopsy – a heart biopsy. Today, a genetic diagnostic test is performed on a blood sample, providing a non-invasive test to help manage the care of patients post-transplant. New research highlights that ongoing testing may be helpful in longer-term patient management by predicting risk of rejection and guiding more tailored immunosuppressive drug regimes.

Status quo - pre and post pandemic

As the trend of CROs setup in India, pharmacogenomics-based company seem to be gaining traction. India has a vast population and there are high incidences of genetic disorders, not to mention mass diversity, which means that there is no one glove-fits-all solution. Companies have started investing in pharmacogenomics as it offers various benefits such as elimination of the unpredictable nature of drug development, bring new products to the market and the company could also benefit up to $200-to-$500 million for each drug.

Like all other aspects of healthcare, the emergence of COVID-19 has impacted many different areas of precision medicine. The pandemic has certainly disturbed surgeries and therefore, testing on biopsy tissue.

Once the disruption caused by COVID begins to reduce and activities settle into a ‘new normal,’ efforts to expand personalized medicine across many diseases will resume. As more physicians learn the lessons of how breast cancer incorporated biomarker testing, disease screening and targeted therapies into standard practices, support for this approach to personalized care will continue to flourish for the benefit of individuals, families and populations.

Accelerating the adoption of personalized medicine

As the ecosystem of stakeholders works to advance personalized medicine, collaboration with policymakers and government regulators is compulsory to promote widespread use of these new tools. The regulatory process must transform in response to advances that are targeted to smaller patient populations based on genetic profiles and policies and legislation must be enacted that provide incentives for the adoption of new technologies and innovative research. Together, progress in the clinical care, research and policy enabling personalized medicine has great calibre to enhance the quality of patient care. Doctors are confident that this is the way forward in medical research.

Summing up

Medicine is moving quickly forward to new precision patient profiling to recognize unique genetic aspects in order to break barriers for diagnosis, treatment and prevention. The chance of a revolutionized healthcare system by personalized medicine will require a great effort by researchers, regulators, clinicians, industries and most of all, patients. The shift from a conception of reactive to a pro-active medicine, associated with the innovation and the ethical issues that is inextricably linked to it, must be considered as a primary goal in the scientific community and health system.