Dr Don Sin on the Barriers to Precision Medicine for COPD

There are several reasons as to why precision therapeutics have not taken off for chronic obstructive pulmonary disease (COPD) in the same way that they have for other diseases, said Don Sin, MD, FRCP, MPH, a professor of respiratory medicine at the University of British Columbia and head of the Centre of Heart Lung Innovation, St. Paul’s Hospital.

There are several reasons as to why precision therapeutics have not taken off for chronic obstructive pulmonary disease (COPD) in the same way that they have for other diseases, said Don Sin, MD, FRCP, MPH, a professor of respiratory medicine at the University of British Columbia and head of the Centre of Heart Lung Innovation, St. Paul’s Hospital.

Transcript

What have been some of the barriers to developing precision medicine for COPD as compared with other illnesses?

Well, it's interesting. The way clinicians practice is through this lens of individualized management. So this, at least some concept, arising from precision medicine has been in vogue for decades at the bedside, but it hasn't really taken off in terms of research, particularly clinical research. And the reason for that is a lot of the therapeutic trials have focused on enrolling thousands if not tens of thousand of individuals to get a significant P value. So you know, to get it registered with FDA and the like, you have to get a P value that's less than .05 and to to do that you increase the sample size to huge amounts. So basically, these therapeutic trials give us an idea of what an average patient would do under the circumstances with the particular therapy in question. And then clinicians are expected to take data from tens of thousands of individuals into their N of one single patient in front of them. And it's been a real challenge to translate these therapeutic trials into clinical practice. So I think that's been one barrier that, you know, therapeutic trials have not been kind to precision medicine, they have been, in fact, going the opposite direction to imprecision medicine. The second is the fact that we haven't had good biomarkers. So something could tell us how the patient will behave under certain circumstances. So if a patient is in front of me, and I have, you know, let's say 5 different therapeutics, I don't have a very good set of tools to figure out which therapeutic of the 5 would work best in that individual. And if we had a good biomarker or some imaging tools or blood test, or some sputum test to guide us in that direction, then we’d be much more precise about which therapeutic to give to that specific individual. And the third aspect is that we there is a relative paucity, certainly in COPD, of the number of therapeutics that are available in our toolkit. And that too, has, I think, limited our application of precision medicine.