Marcos Lopez Hoyos scientific director of IDIVAL, President of the Spanish Society of Immunology (SEI) and head of the Immunology service at the Marqués de Valdecilla University Hospital, attended GM to analyze the reality of precision or personalized medicine in Spain. The expert has assessed the amount of resources that this new paradigm needs, as well as the projects that are carried out from Cantabria.
Ask. Precision medicine stands as the new standard in the short-medium term in Spain. What time is it? What does the SNS need to continue progressing?
Response. We have seen it with COVID-19: we have to invest technical and human resources, we still have very limited resources. The country is advancing the concept of personalized medicine in this field. It is a paradigm shift in medicine; We are no longer going to consider groups of diseases and treat them equally, we must advance in the diagnosis of a patient who has a pathology with characteristics that may be different from other patients and that also change over time. We have to adapt and be practical.
Our country has made considerable progress in cancer, but it is not exclusive to this, but it is applicable to any other disease: inflammatory, respiratory, autoimmune, etc. Precision medicine is based on the use of biomarkers, and many times what is being applied now are genetic and pathological biomarkers in terms of tissue studies, but they are not the only ones: there are many others.
That precision medicine is in a neonatal period. We have to keep moving forward, because it is going to be essential and necessary to be able to apply many of the therapies or treatments that are to come and that are going to totally revolutionize this field.
Q. According to SEOM, its implementation is still a pending issue at the national level. How do you rate it? To what extent has it transformed the day to day in your center?
A. We have a big problem, precision medicine is still ascribed to clinical trials today. This is an activity that is done in all hospitals but is not regulated. Applying precision medicine in the healthcare environment requires a huge investment. We are talking about state-of-the-art biomarkers, which require a very complex technology, and a very high level of ‘know how’ from the people who follow, interpret and study them. That is why it is a very important challenge that must be addressed in the SNS.
In addition, precision medicine requires professionals from other branches who provide interpretation, knowledge and exploitation of the associated data. This medicine has especially impacted the field of rare diseases and oncology, where massive sequencing techniques and cytological markers are used for certain treatments.
“Precision medicine is still attached to clinical trials today, it is done in all hospitals but it is not regulated”
Q. One of the most important claims in precision medicine is the inclusion of biomarkers in the SNS portfolio. How could clinical practice benefit?
R. We have to start applying the specialized resources of this precision medicine to use it in those vital processes with the greatest impact in terms of health and disease and better optimize resources in what is routine. This is going to allow important improvements to, for example, get us out of cancer. For example, in the pathology of pregnancy, it is a pathology that generates a lot of resources, that generates many problems in couples, in people at a very important moment in life, and doing precision medicine in this field can be of great interest. You can use resources for this and optimize them in other situations where you probably don’t care how much you use them.
Q. Do you have any project or initiative in your hospital that confirms the value provided by the use of biomarkers in this field?
R. In Valdecilla the main project, with which we are going to learn a lot, is Cohorte Cantabria. It is a prospective and multidisciplinary cohort that includes the population of Cantabria at an age in which many health events occur, between 40-70 years. We are recruiting a significant number of people, we want to reach 50,000. By having healthy and diseased people, we will be able to learn from everything that happens in these situations and apply many of these biomarkers and omics techniques, which will generate a huge amount of data. We want to relate it to the data we already have from the people who have given us their permission.
In precision medicine we have to start using medical and omic data, but also socioeconomic data, which are essential. We want to advance in that data science to be able to collect information and draw important conclusions. In addition, with these personalized studies we can greatly improve the quality of the health of our population. The main concept is that we do not want to treat groups of pathologies, but each patient with their specific problem.
“We do not want to treat groups of pathologies, but each patient with their specific problem”
P. Cantabria and Valdecilla are committed to an entire infrastructure for the development of this personalized medicine. On what lines does it pivot?
R. In addition to Cohorte Cantabria, we are promoting clinical trials. The Valdecilla unit has worked on early phase trials, in which a lot is learned from all this. With this unit we can be from the beginning in the development of new treatments. Soon, all those that are being implanted are going to have to be accompanied by personalized medicine projects because they are going to have to be associated with biomarkers: a treatment is going to have to be indicated based on the markers that this subject has and their conditions.
At the same time, we have launched the ‘Precision Medicine Forum’, a series of online courses that cover all the specialties led by Valdecilla-IDIVAL researchers. We are going to position them for 2022 and we already have proposals for 2023 to advance precision medicine projects by bringing the best specialists from within and outside the country.