Center for Individualized Medicine uses genomic tools to help improve patient care

Mayo Clinic's Center for Individualized Medicine (CIM) is working actively to discover and translate genomic and molecular science into personalized medical applications. Organized into five translational programs, the center is making strides through efforts in clinomics, pharmacogenomics, biomarker discovery, microbiome and epigenomics to individualize medicine for patients.

This article highlights some of the services provided by three CIM programs and calls your attention to the fourth annual educational conference, Individualizing Medicine 2015: From Promise to Practice, which focuses on how genomic medicine may be used in your practice.

"The genomic era is here," says Keith Stewart, M.B., Ch.B., director, Center for Individualized Medicine. "Patients are savvy, have easy access to information and are wooed by direct-to-consumer testing. As clinicians, we are challenged to keep up with information that is literally changing from month to month, especially genomic tools that are useful in caring for patients.

“Education is key to understanding what personalized medicine can and can't do. The Individualizing Medicine conference provides a forum to distinguish the promise of genomic medicine from practical reality and attracts experts from around the world to educate physicians."

Clinomics Program and Individualized Medicine Clinic

Clinomics is the translation of genomic discoveries into personalized clinical care. In 2012, Mayo's Clinomics Program founded the Individualized Medicine (IM) Clinic, which operates on all three Mayo campuses. The hallmark of the IM Clinic is the multidisciplinary collaboration of Mayo's team of experts, which includes physicians, genomic scientists, genetic counselors, bioinformaticians, laboratory professionals and bioethics representatives from across the institution.

The IM Clinic incorporates advances of genomics into clinical practice, and currently offers DNA sequencing for two types of ailing patients:

  • Individuals with advanced cancers that continue to progress or relapse after standard treatment options have been exhausted
  • Individuals with a chronic and suspected inherited condition, but no definite diagnosis, often referred to as diagnostic odyssey cases.

These service lines use genomic-based tests to reveal variant(s) responsible for a patient's disease and propose potential treatments.

In late summer 2014, the IM Clinic launched Predictive Genomics Services, a consulting service for otherwise healthy patients. This service provides people with opportunities to use genomic tests to learn how they metabolize certain medications, whether they have a predisposition to specific types of disease, and whether they carry a genetic risk of disease that could pass to their children.

Patients seen in the IM Clinic's Predictive Genomics Services receive genomic counseling before testing to provide education about genetics and risk and to help them understand the usefulness and implications of such tests.

Pharmacogenomics Program

Mayo Clinic continues to play a leading role in this rapidly growing application of genomics in the clinic, tailoring medications to meet the needs of each individual. "Drug-gene alerts" are now incorporated into all prescribing tools used at Mayo. The IM Clinic now integrates drug-gene interactions into the patient electronic record, providing individualized, evidence-based support for clinicians prescribing narcotics and medications for psychiatric and cardiovascular disorders.

As the program continues to conduct prospective pharmacogenomic sequencing, additional categories of drug-gene interactions will be embedded into Mayo's electronic medical record to make it possible to individualize drug use for more and more patients.

Related accomplishments and research

RIGHT protocol

This study involves pre-emptive sequencing of 84 pharmacogenes for 1,000 patients in Olmsted County, Minnesota — with the information placed in their electronic records.

BEAUTY breast cancer trial

This genome-sequence-guided clinical trial includes the sequencing of tumor DNA and RNA, as well as patient germline DNA sequencing before and after treatment, plus xenograft generation (for example, growing the tumor in mice) to help guide future care for these patients. BEAUTY has already identified potential biomarkers for drug response and potential drug targets unique to individual patients who relapse after standard chemotherapy.

PROMOTE prostate cancer study

This study uses genomic sequence information to individualize treatment for a group of patients for whom new therapies for prostate cancer are being developed.

TAILOR-PCI trial

Including 23 institutions in three countries, this trial's goal is to determine how to use genomic information to individualize and improve anti-platelet therapy during cardiac stent placement — a major pharmacogenetic issue in cardiology.

Biomarker Discovery Program

Mayo Clinic is increasing its leadership in biomarker discovery to address important clinical questions through genomic and imaging discoveries. Echoing Mayo's approach to clinical care, the Biomarker Discovery Program is a multidisciplinary team that takes a clinical question and answers it through a four-phase approach: discovery, experimental validation, preclinical validation and clinical validation.

The program allows physicians and researchers to apply next-generation sequencing technologies to recurring problems they see in the clinic. The biomarker team has developed a set of novel, proprietary algorithms that help bioinformatics specialists find likely candidate molecules in a fraction of the time it took previously.

Related accomplishments and research

To date, the program has developed 10 new Mayo medical tests and discovered or delivered 29 biomarkers, including indicators to better classify tumors from patients with T-cell lymphoma, biomarkers to distinguish aggressive from indolent prostate cancer tumors and a new biomarker for identifying a specific smoking-related lung cancer.

In the future, this program will focus on developing tests and test panels to aid with endometrial, prostate, ovarian and lung cancer analysis. Biomarker program researchers will also develop imaging biomarkers, including 4-D CT scanning, lung magnetic resonance elastography and biomarkers of fibrosis. Several additional projects with outside collaborators are also underway.