Clinical Perspectives on Targeting Therapies for Personalized Medicine

Abstract

Expected benefits from new technology include more efficient patient selection for clinical trials, more cost-effective treatment pathways for patients and health services and a more profitable accelerated approach for drug developers. Regulatory authorities expect the pharmaceutical and biotechnology industries to accelerate their development of companion diagnostics and companion therapeutics toward the goal of safer and more effective personalized medicine, and expect health services to fund and prescribers to adopt these new therapeutic technologies. This review discusses the importance of a range of new approaches to developing new and reprofiled medicines to treat common and serious diseases, and rare diseases: new network pharmacology approaches, adaptive trial designs with enriched populations more likely to respond safely to treatment, as assessed by companion diagnostics for response and toxicity risk and use of "real world" data. Case studies are described of single and multiple protein drug targets in several important therapeutic areas. These case studies also illustrate the value and complexity of use of selective biomarkers of clinical response and risk of adverse drug effects, either singly or in combination.

Keywords: Adaptive trial design; Biosimilars; Companion diagnostic; Companion therapeutic; Network pharmacology; Pharmacogenetics; Real world data; Transporters.

Figure 1

Economic attractiveness of companion diagnostics to pharmaceutical and biotechnology companies.

Figure 2

Key influx transporters (represented by red (gray in the print version) ovals) belong to the SLC protein family and major efflux transporters (represented by green (gray in the print version) ovals) belong to the ABC protein family.

Figure 3

A network-centric view of drug action maps drug-target (polypharmacology) networks to biological networks. In center part of the biological network, nodes (proteins) targeted by same drug are represented in the same color. Drug efficacy and toxicity are understood by actions at specific nodes and hubs.