Precision Medicine for Heart Failure: Lessons From Oncology.

Abstract

In his State of the Union Address in January 2015, President Barack Obama launched the Precision Medicine Initiative “to bring us closer to curing diseases like cancer and diabetes.” Francis Collins, the Director of the National Institutes of Health, noted that advances in molecular biology, genomics, and bioinformatics and converging trends of increased connectivity through social media and mobile devices had set the stage for the President’s visionary initiative.1 The initiative would start by focusing on cancer. Although cardiovascular disease remains the leading cause of death in the United States, the decisions to focus initially on cancer highlighted the advances in precision medicine for cancer that have clearly outpaced that for any other field of medicine. In fact, cardiology in general and heart failure (HF) specifically have made little progress toward precision medicine. Nonetheless, important lessons can be learned from both the success and failures of precision oncology, which will potentially provide a template for advances toward a precise approach to the therapy of HF and other cardiovascular diseases. The fundamental principle that underlies cancer precision medicine is that molecular analysis of an individual patient’s tumor can enable the identification of the appropriate drug for that tumor which would in turn lead to improved efficacy. Molecular analysis of cancer has been facilitated by the confluence of technological and analytic advances, including the completion of the Human Genome Project,2 the introduction of high-throughput and relatively inexpensive next-generation sequencing,3 and the development of sufficient data storage and computational analytics.4 The Precision Medicine Initiative at the National Cancer Institute has also been facilitated by the Exceptional Responders Initiative and new constructs for clinical trials. In the Molecular Analysis for Therapy Choice (MATCH) program, patients undergo a tumor biopsy followed by next-generation sequencing supplemented by immunohistochemistry or fluorescence in situ …