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The ways in which technology benefits healthcare
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How Personalized Medicine Is Changing: Breast Cancer

How Personalized Medicine Is Changing: Breast Cancer | healthcare technology | Scoop.it

In 2011, a 52-year-old runner and yoga enthusiast walked into the office of Monica Loghin, a neuro-oncologist at MD Anderson Cancer Center in Houston, complaining of numbness and weakness in her lower limbs and difficulty controlling her bladder.

The symptoms were of grave concern, as the patient had previously undergone surgery for breast cancer that had spread to her brain. If such a cancer returns post-surgery, that is often a sign the patient doesn’t have much time left.


An MRI confirmed that the breast cancer had again spread to the woman’s cerebrospinal fluid. Loghin ordered testing of that fluid to see if the patient might have certain biomarkers that could be targeted by existing drugs. (A biomarker is a DNA sequence or protein associated with the disease; different biomarkers can suggest specific treatments, depending on the disease and other factors.) She asked for tests that could detect tumor cells circulating in the blood.


The cancer cells in the fluid bathing the woman’s spinal cord and brain chambers did, in fact, have a lot of the protein that controls a glucose (sugar) transporter that drives cancer cells. The cancer cells in the fluid also had a lot of HER2, a protein associated with aggressive breast cancers but also treatable with a drug called Herceptin (trastuzumab). The drug is usually taken intravenously, but Loghin had heard of a couple of cases in which Herceptin was delivered directly into the cerebrospinal fluid via a flexible tube, or catheter. The patient agreed to this experimental treatment.


It took only a week for the news to improve. After the first infusion of Herceptin, the patient’s cancer numbers were down. Within a few weeks, her cancer cell numbers had fallen so low that her immune system had begun to take over, clearing out the remaining cancer cells. Nearly two and a half years later, the patient is still alive and well enough to do yoga. Another MD Anderson patient who had a similar disease profile and therapy is also alive and well one year after treatment.


This case outlines the dream of personalized medicine: A disease is analyzed at the molecular level. The analysis identifies a drug target. The drug gets delivered where it needs to go. The patient gets better. And while this hopeful scenario has yet to become commonplace, it is becoming more and more the norm for many breast cancer patients.



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Mobile Apps for Cancer Patients

Mobile Apps for Cancer Patients | healthcare technology | Scoop.it

Which apps can be used by chronic cancer patients to help them with their illness and overall health?


There are literally thousands of medical apps in the marketplace and it is very difficult to sift through them and find out which ones are easy to use, practical and helpful.


Joan Justice  did some research, asked some patients, and read a lot of reviews to try and get an idea of which ones were helpful for chronic cancer patients and published this...


It includes some of my recommendations: ClinicalTrialsSeek and Pillboxie along with many others...


read the article here : http://healthworkscollective.com/joan-justice/150181/mobile-apps-chronic-cancer-patients





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A Lot of Action, But Not in the Right Direction: Systematic Review and Content Analysis of Smartphone Applications for the Prevention, Detection, and Management of Cancer

A Lot of Action, But Not in the Right Direction: Systematic Review and Content Analysis of Smartphone Applications for the Prevention, Detection, and Management of Cancer | healthcare technology | Scoop.it

Since the beginning of the 21st century, mobile phones have become nearly ubiquitous. At the end of 2011, there were an estimated 6 billion mobile subscriptions, accounting for approximately 87% of the global population 


Rapid technological convergence has led to the emergence of smartphones—feature-rich phones that combine the voice and text messaging functions of basic phones with powerful computing technology that can support third-party applications, sensing, Internet access, and wireless connectivity with other devices.


According to a 2012 report from the Pew Internet and American Life Project, 85% of US adults own a cell phone of some kind and 53% own a smartphone 


The combination of their popularity, technical capabilities, and proximity to their owners makes them an attractive platform for the delivery of health promotion and disease management interventions 


Systematic review methodology, as described by Moher et al , was used to guide the collection and characterization of eligible apps from the official smartphone stores and the evidence on app utility or effectiveness from the health literature. We developed a systematic search strategy that attempted to identify all relevant apps and studies and we provide a systematic presentation and synthesis of the characteristics of the apps and the studies.


RESULTS:

The search of the mobile phone market yielded 1314 potentially relevant apps, of which 309 apps met our selection criteria (Figure 1); 90.3% (279/309) of apps were available on the iPhone or Android markets . Twelve apps were available on more than one platform (10 were available in two stores and 2 in three stores). Therefore, there were a total of 295 unique apps.


Release date information was available for only 38.0% (112/295) of the apps from Apple, Android, and BlackBerry, as the remainder had produced updated versions and only published their date of update. Release date information was not available for apps on the Nokia market.


Half of the apps (50.2%, 148/295) were free to download. Of those free-to-download apps, 8 were trial versions of the full pay-for-download applications. These free apps offered limited versions of the full apps, restricting access to the full suite of features.


The majority of the apps did not describe their organizational affiliation (64.1%, 189/295). Of those that provided organizational information, 63.2% (67/106) were affiliated with a non-profit, 26.4% (28/106) with a commercial company (eg, Health Monitor Network), 9.4% (10/106) with a university or medical institution, and 1 app was affiliated with a government institution (eg, National Institutes for Health).


Apps affiliated with not-for-profit organizations (non-profit, university, medical institution, or government) were more likely to be free (?21=16.3, P<.001). Apps that did not disclose their affiliation were more likely to have a price (?21=50.1, P<.001).


full article with details at http://www.jmir.org/2013/12/e287/

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Personalized Cancer Treatment: 5 Future Technology Predictions from IBM

Every year IBM makes predictions about 5 technology innovations that stand to change the way we live within the next 5 years. 


This year, one of those 5 is Personalized Cancer Treatment.


In five years, doctors will routinely use your DNA to keep you well. Cancer will be treated on a DNA level in both the patient and tumor, at a scale and speed never before possible. 


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Genetic Link to Skin Cancer Found in Medical Records

Genetic Link to Skin Cancer Found in Medical Records | healthcare technology | Scoop.it
Researchers uncover new ties between genetics and skin cancer by mining patients’ medical records.


Usually, studying the relationship between DNA and disease involves comparing the genomes of thousands of people with a disorder to the genomes of thousands of people who don’t. These studies can be expensive and may take years, requiring researchers to identify patients, enroll them in the study, and collect the genomic data.


A more cost-effective and speedier alternative is to mine the growing pool of genetic data in electronic medical records as reported by researchers in Nature Biotechnology.

These records chronicle a patient’s health care history, which can include physician’s notes, lab test results, and the billing codes hospitals submit to health insurance companies to receive payments.


The idea behind the new method for genetic discover is to be able to “reuse” the data in these records for medical discoveries, says Joshua Denny, a physician-scientist at Vanderbilt University School of Medicine.


To identify previously unknown relationships between disease and DNA variants, Denny and colleagues grouped around 15,000 billing codes from medical records into 1,600 disease categories. Then, the researchers looked for associations between disease categories and DNA data available in each record.


Their biggest new findings all involved skin diseases (just a coincidence, says Josh Denny, the lead author): non melanoma skin cancer and two forms of skin growths called keratosis, one of which is pre-cancerous. The team was able to validate the connection between these conditions and their associated gene variants in other patient data.


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Personalized Immunotherapy for Leukemia Named Breakthrough Therapy

Personalized Immunotherapy for Leukemia Named Breakthrough Therapy | healthcare technology | Scoop.it

A University of Pennsylvania-developed personalized immunotherapy has been awarded the U.S. Food and Drug Administration’s Breakthrough Therapy designation for the treatment of relapsed and refractory adult and pediatric acute lymphoblastic leukemia (ALL). The investigational therapy, known as CTL019, is the first personalized cellular therapy for the treatment of cancer to receive this important classification.


In early-stage clinical trials at the Hospital of the University of Pennsylvania and the Children’s Hospital of Philadelphia, 89% of ALL patients who were not responding to conventional therapies went into complete remission after receiving CTL019.


The investigational treatment pioneered by the Penn team begins by removing patients' T cells via an apheresis process similar to blood donation, then genetically reprogramming them in Penn’s Clinical Cell and Vaccine Production Facility. After being infused back into patients’ bodies, these newly built “hunter” cells both multiply and attack, targeting tumor cells that express a protein called CD19. Tests reveal that the army of hunter cells can grow to more than 10,000 new cells for each single engineered cell patients receive.


source: http://www.dddmag.com/news/2014/07/personalized-immunotherapy-leukemia-named-breakthrough-therapy



more related articles on this :

http://www.chop.edu/service/oncology/pediatric-cancer-research/t-cell-therapy.html


http://online.wsj.com/articles/novartis-wins-breakthrough-status-for-new-leukemia-treatment-1404758105


http://www.novartis.com/newsroom/media-releases/en/2014/1816270.shtml



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Personalized Medicine Best Way to Treat Cancer - Study

Personalized Medicine Best Way to Treat Cancer - Study | healthcare technology | Scoop.it

“If you’re dealing with a disease like cancer that can be arrived at by multiple pathways, it makes sense that you’re not going to find that each patient has taken the same path” - John McDonald, a professor in the School of Biology at the Georgia Institute of Technology in Atlanta.


If a driver is traveling to New York City, I-95 might be their route of choice. But they could also take I-78, I-87 or any number of alternate routes. Most cancers begin similarly, with many possible routes to the same disease. A new study found evidence that assessing the route to cancer on a case-by-case basis might make more sense than basing a patient’s cancer treatment on commonly disrupted genes and pathways.


The study found little or no overlap in the most prominent genetic malfunction associated with each individual patient’s disease compared to malfunctions shared among the group of cancer patients as a whole.
“This paper argues for the importance of personalized medicine, where we treat each person by looking for the etiology of the disease in patients individually,” said McDonald, 


“The findings have ramifications on how we might best optimize cancer treatments as we enter the era of targeted gene therapy.”


The research was published February 11 online in the journal PANCREAS and was funded by the Georgia Tech Foundation and the St. Joseph’s Mercy Foundation.


In the study, researchers collected cancer and normal tissue samples from four patients with pancreatic cancer and also analyzed data from eight other pancreatic cancer patients that had been previously reported in the scientific literature by a separate research group.


McDonald’s team compiled a list of the most aberrantly expressed genes in the cancer tissues isolated from these patients relative to adjacent normal pancreatic tissue.


The study found that collectively 287 genes displayed significant differences in expression in the cancers vs normal tissues. Twenty-two cellular pathways were enriched in cancer samples, with more than half related to the body’s immune response. The researchers ran statistical analyses to determine if the genes most significantly abnormally expressed on an individual patient basis were the same as those identified as most abnormally expressed across the entire group of patients.


The researchers found that the molecular profile of each individual cancer patient was unique in terms of the most significantly disrupted genes and pathways.


more at http://www.news.gatech.edu/2014/02/24/personalized-medicine-best-way-treat-cancer-study-argues


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Emma Pettengale's curator insight, September 9, 10:15 AM

“If you’re dealing with a disease like cancer that can be arrived at by multiple pathways, it makes sense that you’re not going to find that each patient has taken the same path” - John McDonald, a professor in the School of Biology at the Georgia Institute of Technology in Atlanta.

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Optimizing Oncology Clinical Trials with Personalized Medicine

Optimizing Oncology Clinical Trials with Personalized Medicine | healthcare technology | Scoop.it

Personalized medicine is the art and science of “coupling established clinical–pathological indexes with state-of-the-art molecular profiling to create diagnostic, prognostic and therapeutic strategies precisely tailored to each patient’s requirements.”1 


The clinical development and regulatory approval of targeted agents that have therapeutic benefit in molecularly defined patient subsets has highlighted the value of personalized medicine, which can be leveraged in clinical trials so that the identification of eligible patients for certain trials is optimized based on the patient’s molecular testing. These targeted patient groups are often rare and expensive to identify, particularly in the field of oncology, making clinical trials targeting these populations difficult to enroll.


Patient pre-profiling, determining a patient’s tumor-specific molecular profile, could have great value for physicians and patients as they consider potential clinical trial options. To the extent that a molecular profile is broad, encompassing many potential target alterations, one can easily imagine benefits such as more efficient enrollment, increased participation by physicians and patients and more informed treatment decisions. Pre-profiling before a trial is set up at a particular site offers a more efficient approach to enrollment while also providing greater molecular testing to support patient care.

Our current understanding of cancer biology indicates that cancer is a large number of niche diseases that may be targeted with therapies against specific molecular alterations. Drug development under this model creates new challenges for both the development program itself and for patient care. Patient preprofiling promises to leverage high throughput genomic profiling, bioinformatics and, where possible, new trial designs to drive better trial matching and faster enrollment to clinical trials.


Preprofiling may require new relationships and business models, most notably, among patients, clinical sites, biopharmaceutical sponsors and CROs to enable data sharing, site start-up and funding of the genomic testing. The adoption of a new model of patient genomic profiling linked to novel clinical trial designs testing targeted therapies in development is becoming a key response to the challenge to develop many compounds in niche populations in a cost and time sensitive manner.

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CRuiz.11.al.unav's curator insight, November 23, 7:03 AM

La gestión de ensayos clínicos es complicada. En este caso, se añade la dificultad de dividir a los pacientes según sus mutaciones. A medida que la medicina personalizada avanza, se hace más necesaria una colaboración internacional entre centros u hospitales para abarcar a todos los pacientes posibles en los ensayos clínicos. Esto también hace necesario tener en cuenta las diferencias que puedan existir entre las leyes regulatorias de los ensayos clínicos de los distintos países.

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Doctors will routinely use your DNA to keep you well

Doctors will routinely use your DNA to keep you well | healthcare technology | Scoop.it

Learn how doctors will be able to develop targeted cancer therapy based on you and your cancer’s genetics.


How to personalize cancer treatment


Once a doctor sequences your full genome as well as your cancer’s DNA, mapping that information to the right treatment is difficult. Today, these types of DNA-based plans, where available, can take weeks or even months. Cognitive systems will decrease these times, while increasing the availability by providing doctors with information they can use to quickly build a focused treatment plan in just days or even minutes – all via the cloud.


Within five years, deep insights based on DNA sequencing will be accessible to more doctors and patients to help tackle cancer. By using cognitive systems that continuously learn about cancer and the patients who have cancer, the level of care will only improve. No more assumptions about cancer location or type, or any disease with a DNA link, like heart disease and stroke.


more at http://www.research.ibm.com/cognitive-computing/machine-learning-applications/targeted-cancer-therapy.shtml#fbid=2VHk6CaxW6l


directly view the video at http://www.youtube.com/watch?feature=player_embedded&v=0M1DMdc1mQ0

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For Some Cancer Patients, Personalized Medicine Has Arrived

For Some Cancer Patients, Personalized Medicine Has Arrived | healthcare technology | Scoop.it

New tools for analyzing genes are allowing doctors to personalize treatment for some lung cancer patients.


Imagine your doctor being able to scan your DNA from a biopsy and pinpoint the medicine that will work best for you. This type of high-tech approach is a clinical reality for advanced lung cancer at The Ohio State Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).


The technology, known as next generation "multiplex" gene sequencing, analyzes 50-plus genes in DNA extracted from a tumor biopsy for particular genetic mutations.


Previous technology required pathologists to analyze one mutation per tube in a sequencing reaction, but next-generation genome sequencing assesses more than 2,500 mutations in a single reaction. 


Knowing which mutations are present in lung tumors can help doctors tailor a patient's treatment to the unique genetic features present in his or her cancer cells.


The knowledge can also help in the development of new drugs that target previously unrecognized gene mutations in lung tumors. I often compare these genes to the gas pedal in a car — when activated, these genes make the cancer grow. By breaking the linkage between the gas pedal and the motor (or interfering with these "driver" mutations) with specific targeted drugs, doctors can stop this growth and often make the cancer shrink.


That's especially important in lung cancer because the majority of patients with this disease are diagnosed in the later stages, meaning it's important to start effective therapies quickly.


For example, a patient could be given a standard chemotherapy and expect a 25- to 30- percent response rate/shrinkage of a tumor. But if the treatment team knows that a patient has a mutation in a gene called EGFR, we can offer him or her a pill (erlotinib and afatinib are approved for this use in the United States), which has a 75-percent response rate and fewer side effects.


Gene sequencing is now considered the standard of care for stage-4 lung cancer patients at The OSUCCC – James and a handful of other centers across the United States — and several clinical trials evaluating molecular targeted therapies for patients with stage-3 lung cancers will soon start at The OSUCCC – James.


Lung cancer remains the number one cause of cancer death in the United States, and in the world, among both men and women. More than 200,000 cases are diagnosed annually in the United States. Each year during the month of November, physicians and others observe lung cancer awareness month, which sheds light on this terrible disease.

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