The potential of cost-effective precision medicine in the low- and middle-income countries
Wednesday 8 June - 10:00-10:30
photo intervenant Douglas R. LOWY
Acting Director of the National Cancer Institute (NCI) and Chief of the Intramural Laboratory of Cellular Oncology in the Center for Cancer Research at the NCI, Bethesda, USA

Douglas Lowy received his medical degree from the New York University School of Medicine, and trained in internal medicine at Stanford University and dermatology at Yale University. His research includes papillomaviruses and the regulation of normal and neoplastic growth. The papillomavirus research is carried out in close collaboration with John Schiller, with whom he has co-authored more than 100 papers over the past 25 years. In the 1980s, he studied the genetic organization of papillomaviruses and identified the oncogenes encoded by the virus. More recently, he has worked on papillomavirus vaccines and the papillomavirus life cycle. Their laboratory was involved in the initial development, characterization, and clinical testing of the preventive virus-like particle-based HPV vaccines that have been approved by the US Food and Drug Administration and many other countries. It is for this body of work that Drs Lowy and Schiller received the 2007 Federal employee of the year Award from the Partnership for Public Service, the 2007 Dorothy P. Landon-American Association for Cancer Research Prize for Translational Cancer Research, the Sabin gold Medal in 2011, and the National Medal of Technology and Innovation from President Obama in 2014. Dr Lowy also received the 2007 Medal of Honor for basic research from the American Cancer Society. He is listed by the Institute for Scientific Information as one of the most highly cited authors in microbiology, and is a member of the National Academy of Sciences and the Institute of Medicine of the NAS.

The potential of cost-effective precision medicine in the low- and middle-income countries

Although precision medicine in oncology (precision oncology) is often discussed as though it is primarily concerned with new targeted cancer treatment, which is usually expensive, precision oncology approaches are equally applicable to disease prevention and screening, and may be relevant in low- and middle-income countries (LMICs).  Precision oncology includes interventions to prevent, diagnose, or treat cancer, based on a molecular or mechanistic understanding of the causes, pathogenesis, or pathology of the disease.  Where the individual characteristics of the patient are sufficiently distinct, interventions can be concentrated on those who will benefit, sparing expense and side effects for those who will not.
Two examples of precision medicine relevant to LMICs are HPV-based testing for cervical cancer screening and HPV vaccination for cancer prevention.  Both approaches are derived from identification of HPV as the main etiologic agent for virtually all cases of cervical cancer.  Compared with cytology, the greater sensitivity and negative predictability of HPV-based screening enables screening intervals to be longer than with cytology.  Furthermore, less training is required for high quality HPV testing than for high quality cytological testing.  In principle, HPV vaccination can prevent the vast majority of cervical cancers attributable to the HPV types targeted by the vaccine.  The first generation HPV vaccines target HPV16/18, which together account for about 70% of cervical cancer.  The second generation HPV vaccine targets more HPV types, which together account for close to 90% of cervical cancer.  Tiered pricing by the commercial producers of the vaccines has made them more affordable in LMICs.  The number of doses required for young adolescents has recently been reduced from three to two, and some post-hoc research raises the possibility that new clinical trials may develop evidence that even a single HPV vaccine dose could be sufficient for inducing long-term protection.