Personalized medicine:a paradigm shift is gaining momentum

Interview with Prof. Nisar Malek, Medical Director of the Clinic for Gastroenterology, Hepatology and Infectious Diseases at the University Hospital Tübingen and Chairman of the Center for Personalized Medicine (CPM) Tübingen

Personalized medicine does not follow a "one-size-fits-all" treatment approach but emphasizes a "tailor-made" paradigm, meaning a treatment is customized to each individual person's case. For patients, this increases the chances of treatment success and means fewer side effects. While the approach originates in the field of oncology, it is now also increasingly applied to other disease patterns. The CPM Tübingen also implements this approach.

Prof. Nisar Malek
Prof. Nisar Malek

In this interview with, Prof. Nisar Malek talks about the application of personalized medicine in various fields, explains how various medical disciplines at the CPM collaborate in this area and describes the role personalized medicine might play in the future.

Prof. Malek, what is personalized medicine?

Prof. Nisar Malek: Personalized medicine denotes a paradigm shift in medicine that has been ongoing for several years and one that no longer treats each patient by following the same diagnostic and treatment approach for a specific disease. Personalized medicine addresses the patient’s individual situation and most notably his or her genetic predispositions.

What are the diseases personalized medicine focuses on today?

Malek: Until now, it primarily focused on different types of cancer. For example, from the outside, colon cancers seem to be similar or at least comparable. However, at the genetic level, they often have very different causes that also require different approaches to treat the patient.

Today, the principles of personalized medicine are also increasingly expanded to other areas such as immune-mediated diseases like rheumatism, inflammatory bowel diseases or multiple sclerosis, as well as neurological, cardiovascular or infectious diseases.

The interdisciplinary cooperation between different medical areas plays an important role in the process to find a personalized therapy for every patient.

Earlier you called personalized medicine a "paradigm shift". How important is it in today's clinical practice?

Malek: These days, more and more patients are treated by using some aspects of personalized medicine. The individual techniques and technologies or components of this approach that facilitate a personalized treatment are applied in different areas. Genetic testing, functional imaging, which allows us to shed light on tissue activity or diagnostic molecular pathology are some examples of this. We originally used these techniques in oncology, but they are also increasingly being applied outside the field of oncology.

What are your goals at the CPM in Tübingen?

Malek: Our first goal – and this is also our overriding goal – aims to further refine diagnostics and treatment for the individual patient and preferably integrate this into as many medical specialties as possible.

Our second goal is to collect diagnostic and treatment data and transfer it into databases, making them usable through medical and bioinformatics processes to draw conclusions about the individual patient. This is where we touch on the area of big data.

Experts from different medical areas discuss cases in so-called tumor boards to find treatment options together. At the CPM in Tübingen, 23 clinics and institutes take part in the personalized treatment.

Does personalized medicine actually create added value? What has your experience at CPM been so far?

Malek: A little over a year ago, we set up so-called molecular tumor boards. These are interdisciplinary expert meetings where colleagues from molecular biology, human genetics, and bioinformatics, for example, discuss and choose individualized treatments for individual patients. This is done based on the genetic profile of a tumor for example. That being said, we also include immunotherapy, peptide vaccines, and individualized radiotherapy at this point. From my perspective, the new technologies and the interdisciplinary exchange have opened up further treatment options, especially for patients with advanced cancer where we used to be unable to offer any other treatments.

Personalized medicine is most tangible and advanced in oncology because we have many new drugs available in this area that allow a targeted disease intervention. Having said that, we are confident that more and more patients are going to benefit from it in the future. After all, we aim to also set up corresponding structures and decision boards for immune-mediated and neurological disorders in 2018.

What future developments do you see in personalized medicine?

Malek: I believe it will become the defining paradigm of medicine in the future – based on the enormous progress we have made in the diagnostics and targeted treatment of diseases. Obviously, it will not gain a foothold in all areas, when it relates to fractures, heart attacks or pneumonia for example. We are simply too far advanced in these fields and know exactly what we need to do in these cases. However, when it comes to more complex diseases such as age-related diseases, cancers, neurodegenerative or immune-mediated diseases, its principles will be crucial. It will help us to make fundamental treatment advances we were unable to make for many years in these settings.

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.