个人化医疗PersonalizedMedicinePersonalizedmedicineistheuseof.PPTVIP

* * * * * * * * * * * * * * * * * * * * * * Symptoms vs. Genetic-based Medicine Symptoms-based ? Symptomatic diagnosis, prescription monitoring ? Treatment Targets selected based on largest population ? Blockbuster drug for all patients effective in only 40-60% and can have adverse drug reactions (ADR) ? Reactive Symptoms vs. Genetic-based Medicine Genetic-based ? Molecular Diagnosis ? Risk-stratification by molecular ? Drug-targeted therapy ? Less or no ADR ? Molecular monitoring of disease ? Preventive Genetics and Genomics in Clinical Medicine Assessment of risk (eg., Breast cancer and Colon cancer) Pharmacogenomics – Efficacy of drugs based on genomic changes Pharmacogenetics – Efficacy of drugs based on genetic differences Personalized Medicine involve Risk stratification Inform treatment selection Inform dosage Prognostic testing Treatment monitoring Improve or optimize clinical treatment pathways --------- Genomic Tools for Prediction andPersonalized Care Pharmacogenomics Strategy 大腸直腸癌藥物治療的預後與相關代謝的基因表現相關 個人化癌症藥物治療 Which drug should I use? Tamoxifen(ER), Herceptin(Her-2),Glivec(CML Bcr-Abl),Erbitux(EGFR),Tarceva(EGFR) How much of the drug do I need? Camptosar(UGT1A1) Is the drug working ? Glivec(CML QT-PCR for Bcr-Abl) Personalized Medicine: Fears Pharma Payers Doctors Patients Regulators Diagnostics Reduce market Add cost without return Too prescriptive Will I be denied access to new drugs? How do handle new complexities? More tests with poor reimbursement Personalized Medicine The right drug or treatment, atthe right time, for the rightpatient, at the right cost 對的治療 對的時間 對的患者 對的代價 * * (multiple cumulative alterations to the cell’s DNA leading to genetic damage.) * * * * * * * * * Surgery and radiation remove or kill the bulk of locoregional cancer; however, small local tumor deposits and occult metastases may escape these treatments and result in subsequent recurrence or relapse. Cytotoxic chemotherapy agents work by a variety of mechanis