Personalised medicine at Roche

Rebecca Aris interviews Jaime del Barrio Seoane

Instituto Roche

pharmaphorum interviews Jaime del Barrio Seoane, Director General del Instituto Roche in Spain on personalised medicine adoption, barriers to adoption and when he expects personalised medicine to be part of clinical practice.

The goal of personalised medicine is to achieve the best clinical results through the knowledge of the individual genetic profile together with other factors.

The purpose of the Roche Institute, Spain, is to promote the approach of personalised medicine to the surrounding society to allow personalised medicine to become a reality in the National Health System.

In this interview with Jaime del Barrio Seoane, Director General del Instituto Roche, we hear his views on when personalised medicine will become part of clinical practice, the current barriers to adoption on personalised medicine and how he thinks they can be overcome.

Interview summary

RA: Jaime, could you please start by telling me more about the work of the Roche Institute with regards to personalised medicine.

JB: Instituto Roche is a foundation established by Roche Pharma Spain in 2004, and has personalised medicine as a common thread to all its activities.

Since the dawn of the century, advances in the knowledge of the human genome are bringing us faster than ever to the Hippocratic view that there are no diseases, only patients. We promote expert working groups, consensus documents, off- and online education and scientific meetings in all fields related to personalised medicine, from basic to translational and applied science, including the legal and ethical aspects of these novel fields.

RA: How do you define individualised medicine?

JB: By individualised or personalised medicine we refer to the design and application of preventive, diagnostic and therapeutic interventions better fitted to the genetic substrate of each patient and the molecular profile of every disease.

The main drivers making personalised medicine possible today are three:

i) the risk-benefit balance and uneven efficacy of treatments, where there’s plenty of room for improvement,

ii) economic aspects, and the cost-benefit ratio, which at first glance is becoming more unfavorable due to the high price of the new targeted therapies (biologic drugs and small molecule inhibitors) but, mainly, because the pharmaceutical drug discovery and development process is probably as inefficient as it ever has been, which has an important economic cost, and

iii) advances in genetics, genomics and molecular biology in the last decade, which have considerably increased our understanding of interindividual variability and the molecular basis of disease, importantly, these are now within reach of many labs and healthcare institutions thanks to the decreasing cost of and improvement of high-throughput technologies and bioinformatics.

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“…many doctors have not been educated in basic genetics and molecular biology…”

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RA: What do you see to be the biggest challenges in individualised medicine?

The biggest challenges facing personalised medicine are related to making future healthcare more systematic and efficient. This will be achieved by identifying differences among patient subgroups and gaining a deeper understanding of disease sub-categories. This knowledge is already being applied to the discovery of the best targets for new drugs and to develop new biomarkers and diagnostic tests.

RA: What recent advances in individualised medicine are you the most excited about?

We are witnessing exciting developments in many therapeutic areas where many patients are in need of more accurate diagnosis and more efficacious treatments. Take for instance metastatic melanoma, the deadliest form of skin cancer, where doctors and patients are being given new hope through the combination of precise molecular diagnosis and targeted therapies. There are similar developments in many areas, including many types of cancer, hepatitis B, and others. If we look back at breast cancer ten years ago, and see what targeted therapy for the HER2 over-expressing group of patients has achieved, we can better understand how profound and far-reaching this change is bound to be.

RA: How can we better educate health professionals and the general public in the area of personalised medicine to make sure individualised medicine becomes a reality?

Precisely, one of the bigger challenges is to introduce these advances as quickly as possible and in the best possible conditions into routine clinical practice. What we are seeing in most countries, though, is that many doctors have not been educated in basic genetics and molecular biology, mainly because most medical schools are only beginning to integrate this knowledge in their academic curricula. Yet, patients today are better informed than ever, and they are actively searching the internet for their optimal therapeutic options, so clinicians need to be up-to-date in this field. This is one of the main raisons d’etre for Instituto Roche. We want to raise awareness and educate clinicians and society at large on the importance of these discoveries, and promote multidisciplinary working groups, endorsed whenever possible by academic institutions and medical societies.

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“Most prospective analyses envisage the decade starting in 2020 as the time when personalised medicine will become routine.”

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RA: What do you think the field of individualised medicine will look like in ten years time?

Most prospective analyses envisage the decade starting in 2020 as the time when personalised medicine will become routine. It won’t be easy, or even possible or beneficial (yet) for some diseases, but it cannot be stopped. Research is making big strides down paths that were unimaginable not long ago, thanks to affordable new technologies and collaborative work among teams all around the world.

The current economic crisis cannot be an excuse to slow down these developments, instead, it is an opportunity to foster them and contribute in a decisive manner to the change that we need in healthcare: new training materials and resources, evolving roles for the different stakeholders in healthcare, implementation and optimization of new processes… in short, we need to invest ourselves into change management.

Personalised medicine, through its reliance on more accurate diagnosis and safer, more efficacious targeted medicines, is a formidable asset for the better use of healthcare resources, which are always limited. Healthcare and social benefits will be unquestionable. We must have a long-term vision to adapt to the pace of knowledge, although it doesn’t take much because the body of evidence is becoming overwhelming. It is up to all of us, as a society, to embrace and foster these developments that are providing solutions to many untreatable conditions, and thereby alleviating so much pain and suffering.

RA: And finally, what next for the Roche Institute in Spain?

We at Instituto Roche want to keep anticipating and adapting to advances in all fields related with personalised medicine, and are planning our actions accordingly.

We know that most, and in some pharmaceutical companies all, of the drugs in clinical development are being developed together with companion diagnostics. So the introduction of these strategies into healthcare systems is an opportunity for us to collaborate with all stakeholders, be they scientists, clinicians, hospital and healthcare managers, regulatory agencies, policy makers, patients and society at large.

This has always been our ambition and we intend to keep working along those lines, with a special interest in the new ethical and legal challenges posed by the extensive introduction of genetic data into medical records. This will not only impact the patient-doctor relationship, but also the patient’s relationship with their families, as genetic information is shared among relatives.

In short, we want to contribute to our society’s effort to make these new technologies available and affordable to every citizen, in order to keep our healthcare system sustainable in the long term.

RA: Thank you for your time.

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About the interviewee:

Jaime del Barrio Seoane is the Director General del Instituto Roche in Spain. He has held this position since 2003.

He holds a degree in Medicine and Surgery (MD) from the University of Cantabria, Spain.

Jaime is a member of the Real Academia de Medicina de Cantabria and of several Scientific Societies. In addition, he has authored several articles, books, publications, communications and professional papers.

How can genetics and molecular biology be better integrated into medical schools?