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Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report (2014)

Chapter: Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report

Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
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Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 2
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 3
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 4
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 5
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 6
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 7
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 8
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 9
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 10
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 11
Suggested Citation:"Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report." National Academies of Sciences, Engineering, and Medicine. 2014. Roundtable on Translating Genomic-Based Research for Health: 2013 Annual Report. Washington, DC: The National Academies Press. doi: 10.17226/26252.
×
Page 12

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BOARD ON HEALTH SCIENCES POLICY Roundtable on Translating Genomic-Based Research for Health 2013 Annual Report

Message from the Co-Chairs The promise of genomics to improve health care is now becoming a reality. Decreasing genome sequencing costs and innovative science have placed genomics and related molecular tools at the center of biomedical research. New molecular tools are being used to diagnose disease, predict the potential for adverse events, reduce the use of unnecessary medical services, and tailor therapeutic regimens. As genomic medicine advances, it holds the tremendous potential to enable the health care system to provide improved and more accessible care at a lower cost. However, translation into health care applications remains challenging due to a currently underdeveloped evidence base, a misalignment between basic research and clinical needs, and the lack of a robust knowledge generating system that incor- porates genomic information from both basic and clinical research. Many important questions must be addressed to ensure that this new technology is appropriately adopted, but overcoming these obstacles is not an easy task. The Roundtable on Translating Genomic-Based Research for Health provides an opportunity for strategic thinking and action to solve these paramount issues. Since its establishment in 2007, the Roundtable has organized and hosted 21 meetings and 17 public workshops and published 13 workshop summary reports. During these meetings, the Roundtable has explored areas including challenges for genomics, such as return of incidental findings from genome sequencing; improving the efficiency of translation of genomic applications; impediments to bringing basic research discoveries into clinical trials; integration of genomic information into health information technology systems; sys- tems approaches to developing evidence for genomic applications and their evaluation; economic issues associated with precision medicine; genome-based strategies for drug and diagnostic discovery and development; and ethical considerations in conducting genomics research. As a forum for academia, industry, advocacy and provider groups, government, and others, we stimulate discussion, press to clarify complex concepts, and seek pathways to solutions. In 2013, the Roundtable sponsored workshops and meetings on the co-development of molecular diagnostics and targeted therapeutics, conflict of interest and medical innovation, and drug repurposing. Essential to our process is discourse that allows all perspectives to be voiced, with special attention given to clarifying competing views and identifying actions and strategies for resolving issues. Our agenda for 2014 will include further exploration of grand challenges for genomics—identifying key issues in the evi- dence evaluation process for genomic technologies, examining pragmatic approaches to educating health care provid- ers about genomics, working with vendors and end users on integrating genomic information into the electronic health record, and developing a framework for investigators and industry to acquire DNA routinely as part of clinical trials. The Roundtable recently welcomed new sponsoring members from the American Academy of Nursing, the Association for Molecular Pathology, the International Society for Cardiovascular Translational Research, the National Institute of Nursing Research, and PhRMA. We welcome our new members and look forward to a productive year with the partici- pation of all stakeholders. Sincerely, Geoffrey S. Ginsburg, M.D., Ph.D. Sharon F. Terry, M.A. Director, Center for Genomic Medicine President & CEO Institute for Genomic Sciences & Policy Genetic Alliance Duke University

Reflecting Back: Roundtable Activities in 2013 Reflecting Back Roundtable Activities in 2013 Roundtable Meetings Roundtable members met four times in 2013 to continue their discussions on emerging and enduring issues in advancing the field of genomics. Meeting topics that were discussed included development of a knowledgeable health care system for precision medicine; evidentiary issues; education, engagement, and cultural change needed to implement genomic medicine; governance and ethical issues; research strategies to identify therapeutic targets based on genetic factors influenc- ing human life span and health span; and integration of genomic information into health information technology systems. Roundtable Workshops Refining Processes for the Co-Development of Genome-Based Therapeutics and Companion Diagnostic Tests (February 27, 2013) Genome information can identify new drug targets for both common and rare diseases, can identify patients predicted to respond to a specific treatment, and has the potential to significantly reduce the cost of clinical trials by reducing the number of patients that must be enrolled to demonstrate safety and efficacy. Recently, benefits such as these have led to the development and approval of a number of targeted therapeutics for diseases such as non-small-cell lung cancer, metastatic melanoma, and cystic fibrosis. A key component of each of these new drug approvals is the ability to identify the population of patients who will benefit from treatment, which has largely hinged on the co-development and co-submis- sion to the U.S. Food and Drug Administration (FDA) of a companion molecular test. This has led to a major alteration in the way that drugs are being developed, with traditionally separate entities— pharmaceutical and diagnostic companies— now working in close collaboration.

Although these early co-development successes have bolstered the industry and demon- strated to some extent the efficacy of a genomics-based approach to drug discovery and development, this convergence has not occurred without issue. Questions remain regarding the economic viability of co-development for diagnostics, payer reimbursement for com- panion tests and off-label use of these drugs, the substitution of non-FDA approved tests, the challenges in changing technologies for an existing companion diagnostic, the need for multiple tests for limited amounts of diagnostic tissue specimens, and many others. The Roundtable hosted a workshop to examine the challenges of and potential solutions for co-development of molecular tests and targeted therapeutics. Conflict of Interest and Medical Innovation: Ensuring Integrity While Facilitating Innovation in Medical Research (June 5, 2013) New scientific innovations, such as the sequencing of the human genome, hold the promise for improving human health through greater understanding of disease biology and the devel- opment of new drugs, diagnostics, and preventive services. However, few basic research dis- coveries from these advancements have been translated into appreciable clinical applications, partly because of the complexity of the underlying biology, a lack of resources to validate the discoveries, and the cost and time it takes to develop a product. Business models are adapting to this new reality by placing increasing emphasis on the use of alliances, joint development efforts, early phase research partnerships, and public-private partnerships that have many potential benefits for the parties involved as well as the public. Although the potential benefit of collaboration is great, scientific integrity and public trust must also be ensured by identifying, disclosing, and managing conflicts of interest (COI) that could create bias in the research being performed. The Roundtable hosted a workshop to examine and discuss the effect of current COI policies—both public and private—on medi- cal innovation. The goals of the workshop were to articulate and clarify COI policies in the context of the current landscape for medical advancement, examine the impact of COI policies on innovation, and identify best practices to facilitate innovation under the current COI policies while still ensuring scientific integrity and public trust. Stakeholders, including government officials, pharmaceutical company representatives, academic administrators and December 4 Diffusion and Use of Genomic July 11-12 Innovations in Health and Meeting 1 Medicine Workshop ROUNDTABLE TIMELINE 2007 2008 December 5 Meeting 2

Reflecting Back: Roundtable Activities in 2013 researchers, health care providers, medical ethicists, and consumers presented their perspectives and participated in discussions during the workshop. Genomics-Enabled Drug Repurposing and Repositioning (June 24, 2013) The path of drug development can be expensive and time-consuming. Recent estimates predict, on average, an expenditure of at least $1 billion and a time frame of ten years to bring a drug to market. Although spending on drug research has increased, the number of drugs approved by FDA has not. In response, pharmaceutical companies are examin- ing options to either give non-commercially available drugs a new chance at approval or to search for new indications for existing drugs. Technological advances and the increasing availability of genomic data and computational systems have resulted in new methods to systematically identify both drug targets and pathways for detect- ing drugs with a secondary, often seemingly unrelated, indication. The Roundtable hosted a workshop to assess the current landscape of drug repurposing activities in industry, academia, and government; examine enabling tools and technology; and evaluate the business models and economic incentives for drug repurposing programs. Stakeholders, including government officials, pharmaceutical company representatives, academic researchers, regulators, funders, and patients were invited to present their perspectives and participate in discussions during the workshop. July 28 Innovations in Service April 1-2 Delivery in the Age of October 6-7 Meeting 3 Genomics Workshop Meeting 5 2008 July 29 Meeting 4

Looking Forward Roundtable Activities in 2014 Roundtable Meetings The Roundtable members will meet three times in 2014 to discuss various issues for the field of genomics. Roundtable members will discuss the challenges and opportunities for integrat- ing genomic information into the electronic medical record, strategies for sharing clinical trial data, international efforts in genomic medicine, and focused genomic screening of com- panion genes for complex diseases. Roundtable Workshops Assessing Genomic Sequencing Information for Health Care Decision Making (February 3, 2014) The sequencing of the human genome has led to tremendous advances in research and devel- opment, increasing our understanding of the basis of disease and hastening genetic-based targeted therapeutic development. Over the past ten years, these advances have been buoyed by the equally significant advances in technologies that have increased accuracy and lowered genome sequencing costs from $2.7 billion in 2003 to $1,000 today. As a result of these scientific and techno- logical advances, large-scale genome sequencing is begin- ning to move into clinical prac- tice for determining patient treatment options. The clinical use of sequencing relies on the February 12 August 31-September 1 Systems for Research and Evaluation for Translating Direct-to-Consumer Genetic Genome-Based Discoveries for Health Workshop Testing Workshop 2009 February 13 June 9-11 Meeting 6 Meeting 7

identification of linkages between genetic Looking Forward: Roundtable Activities in 2014 variants or groups of variants and dis- ease. These findings may enhance patient care, but most associations have not been rigorously confirmed and may only play a minor role in disease. Until ideal infor- mation is developed, best practices for gathering and evaluating the available evidence are needed. The Roundtable will host a workshop to examine how evidence for genomic applications is gathered and assessed for clinical and reimbursement decision making, guideline development, and patient care and health decisions in the absence of an ideal evidence base. Facilitating the Integration of Genomic Information into the Electronic Health Record (December 8, 2014) The sequencing of the human genome has facilitated a tremendous increase in our understanding of disease. This greater understanding, combined with the technological advances that have significantly improved genome sequencing accuracy while decreas- ing its cost, has led to large-scale sequencing now being used in clinical practice to aid in diagnosis and to identify treatment options for patients. With the expanded use of elec- tronic health records (EHRs) by hospitals and physicians, EHRs offer vast potential to derive knowledge of disease, treatment efficacy, outcomes, and drug safety. However, the current health care system is largely unprepared to handle genomic data. There is a lack of standards for the data, and interoperability, scalability, privacy, security, and storage issues need to be resolved. The Roundtable is planning to host a workshop to examine how genomic information could be effectively integrated into EHRs. Stakeholder groups may include EHR developers and health information technology professionals, clinical provid- ers and other institutional end users of these platforms, academic researchers, patient groups, and government representatives, who will be asked to present their perspectives and participate in discussions during the workshop. May 24 Challenges and Opportunities March 22 in Using Newborn Screening The Value of Genetic and Genomic Samples for Translational July 23 Technologies Workshop Research Workshop; Meeting 10 Meeting 11 2010 November 16-17 March 23 July 22 Meeting 8 Meeting 9 Establishing Precompetitive Collaborations to Stimulate Genomics-Driven Drug Development Workshop

Working Groups Four working groups have been established within the Roundtable to examine various topics and aspects of translating genomic information into appreciable health care applications. Each group meets regularly by teleconference as well as in person at Roundtable meetings. Together, they discuss issues of mutual interest to the group as well as suggest, plan, and complete Roundtable workshops, seminars, and commissioned papers. Education, Engagement, and Cultural Change Many factors influence the adoption of new technologies across a health care system. Market forces, profit/loss ratios, and competitive advantage are several aspects that may be evaluated by insti- tutional administrators when considering the implementation of a new program. The Education, Engagement, and Cultural Change (EECC) group is working to gain a better understanding of the major drivers of decision making at the institutional level with regard to adopting genomic medi- cine programs. In addition, the EECC group will be evaluating pragmatic approaches to improving genetics education for health care providers and the cultural barriers and change needed to facili- tate this education. Evidence Over the last ten years, there has been an exponential increase in the number of single base changes that have been associated with diseases, including Alzheimer’s disease and type 2 diabetes. This information can potentially be used to greatly enhance the care that patients receive. However, the evidence base for the majority of these associations is not developed enough for many stakeholders to use for decision making purposes—in particular, clinical care and patient management, reim- bursement policies, and guideline development. Members of the Evidence group are working to examine how non-ideal evidence can be used in health care decision making. November 17 July 19 Generating Evidence for Integrating Large-Scale Genomic Diagnostic Test February 22-23 Genomic Information into Development Workshop Meeting 13 Clinical Practice Workshop 2011 November 18 July 20 Meeting 12 Meeting 14

Reports Released in 2013 Working Groups Knowledgeable Health Care System for The Economics of Precision Medicine Genomic Medicine: Workshop Summary Genomic data are increasingly being generated in the clinical practice of medicine with genome sequencing being used to direct therapeutic prescribing as well as patient management. Significant questions exist regarding how to incorporate this genomic informa- tion into the electronic health record, the standards for doing so, and the readiness and interoperability of the current system to accept these data to be usable Sharing Clinical over a lifetime for directing care. The Knowledgeable Research Data: Health Care System for Precision Medicine group is Workshop Summary working with electronic health record vendors and clinical end users on issues related to the integration of genomic information into the electronic health record in a manner that is useful for both clinical practice as well as research. Overview Group The Overview group examines cross-cutting issues Genome Based for all members and working groups and responds Diagnostics: to emerging issues within the genetics and genom- Demonstrating Clinical Utility ics field. Currently, this group is focusing its efforts in Oncology: on DNA collection and data generation in clinical Workshop Summary trial designs. March 21 New Paradigms in Drug November 15 Discovery: How Genomic Data July 17-18 October 4-5 Facilitating Development and Are Being Used to Revolutionize Assessing the Sharing Clinical Utilization of Genome-Based the Drug Discovery and Economics of Genomic Research Data Diagnostic Technologies Workshop Development Process Workshop Medicine Workshop Workshop 2012 May 24 November 16 March 22 July 18 Meeting 15 Meeting 16 Evidence for Clinical Utility of Molecular Meeting 17 Diagnostics in Oncology Workshop

Roundtable Members (as of December 2013) Geoffrey S. Ginsburg, M.D., Ph.D. Richard Hodes, M.D. Katherine Johansen Taber, Ph.D. (Co-Chair) National Institute on Aging American Medical Association Duke University Muin Khoury, M.D., Ph.D. David Veenstra, Pharm.D., Ph.D. Sharon F. Terry, M.A. (Co-Chair) Centers for Disease Control and University of Washington Genetic Alliance Prevention Michael S. Watson, Ph.D. Naomi Aronson, Ph.D. Gabriela Lavezzari, Ph.D. American College of Medical Genetics Blue Cross and Blue Shield Association PhRMA and Genomics Euan Ashley, M.R.C.P., D.Phil., FACC, FAHA Thomas Lehner, Ph.D., M.P.H Daniel Wattendorf, M.D. (Lt. Col) American Heart Association National Institute of Mental Health Department of the Air Force Paul R. Billings, M.D., Ph.D. Debra Leonard, M.D., Ph.D. Catherine A. Wicklund, M.S., C.G.C. Life Technologies Corporation College of American Pathologists National Society of Genetic Counselors Bruce Blumberg, M.D. Teri A. Manolio, M.D., Ph.D. Janet K. Williams, Ph.D., R.N., FAAN Kaiser Permanente National Human Genome Research American Academy of Nursing Pamela Bradley, Ph.D. Institute U.S. Food and Drug Administration Olufunmilayo F. Olopade, M.D., FACP, OON Roundtable Staff Philip J. Brooks, Ph.D. The University of Chicago Office of Rare Diseases Research Adam C. Berger, Ph.D. Ann Cashion, Ph.D. Michelle Ann Penny, Ph.D. Project Director Eli Lilly and Company National Institute of Nursing Research Sarah H. Beachy, Ph.D. C. Thomas Caskey, M.D., FACP Aidan Power, M.B., B.Ch., M.Sc., Associate Program Officer M.R.C.Psych. Baylor College of Medicine Sean P. David, M.D., S.M., D.Phil. Pfizer Inc. Robert B. Darnell, M.D., Ph.D. James C. Puffer, M.D./American Board of The Rockefeller University Victoria M. Pratt, Ph.D., FACMG Family Medicine Fellow Association for Molecular Pathology Stanford University School of Medicine Michael J. Dougherty, Ph.D. American Society of Human Genetics Ronald Przygodzki, M.D. Samuel G. Johnson, Pharm.D., BCPS Department of Veterans Affairs IOM Anniversary Fellow in Pharmacy Victor Dzau, M.D. Mary V. Relling, Pharm.D. Kaiser Permanente Colorado Duke University Health System St. Jude Children’s Research Hospital Tonia Dickerson W. Gregory Feero, M.D., Ph.D. Allen D. Roses, M.D. Senior Program Assistant Journal of the American Medical Association Duke University Andrew N. Freedman, Ph.D. Joan A. Scott, M.S., C.G.C. Board on Health Sciences Health Resources and Services National Cancer Institute Policy Staff Administration Jennifer L. Hall, Ph.D., FAHA, FACC Andrew M. Pope, Ph.D. International Society for Cardiovascular Sam Shekar, M.D., M.P.H. Northrop Grumman Information Systems Director Translational Research February 27 December 3 Refining Processes for Improving the Efficiency the Co-Development of June 24 and Effectiveness Genome-Based Therapeutics Genomics-Enabled of Genomic Science and Companion Diagnostic Drug Repurposing and June 25 December 4-5 Translation Workshop Tests Workshop Repositioning Workshop Meeting 20 Meeting 21 2013 2014 June 5 December 4 February 28 Conflict of Interest and Medical Innovation: Ensuring Integrity Meeting 18 Meeting 19 While Facilitating Innovation in Medical Research Workshop

Roundtable Sponsors Roundtable Members and Sponsorship (as of December 2013) American Academy of Nursing American College of Medical Genetics and Genomics American Heart Association Patient Advocacy American Medical Association American Society of Human Genetics 4% Association for Molecular Pathology Foundations and Blue Cross and Blue Shield Association Associations 41% Centers for Disease Control and Prevention 33% Government College of American Pathologists Department of Veterans Affairs Eli Lilly and Company 4% Genetic Alliance 18% Health Resources and Services Administration International Society for Cardiovascular Translational Research Miscellaneous The Kaiser Permanente Program Offices Community Benefit II Nonprofit at the East Bay Community Foundation Industry Life Technologies Corporation National Cancer Institute National Coalition for Health Professional Education in Genetics National Human Genome Research Institute National Institute on Aging National Institute of Mental Health National Institute of Nursing Research National Society of Genetic Counselors Northrop Grumman Pfizer Inc. PhRMA United States Air Force December 8 February 3 August 18 Facilitating the Integration Assessing Genomic Sequencing Improving Genetics of Genomic Information Information for Health Care Education for Health Care into the Electronic Health Decision Making Workshop Providers Workshop Record Workshop 2015 February 4 August 19 December 9 Meeting 22 Meeting 23 Meeting 24

About the Genomics Roundtable The Institute of Medicine of The National Academies established a Roundtable on Translating Genomic-Based Research for Health to provide both a mechanism and a venue for interested parties from government, academia, industry, and other stakeholder groups to meet and discuss global issues of mutual interest and con- cern regarding the translation of genomics research findings in a neutral setting. The primary purpose of the Roundtable is to foster dialogue across sectors and among interested parties and institutions, and to illuminate and scrutinize critical scientific and policy issues. The Roundtable explores and implements strategies for improving health through the translation of genomics and genetics research findings into medicine, public health, education, and policy. During the two to three meetings the Roundtable holds each year, specific scientific and policy issues will be identified and dis- cussed that will help further the field of genomics and enable the translation of genomics into health care applications. For more information about the Roundtable on Translating Genomic-Based Research for Health, please visit our website at www.iom.edu/genomicroundtable or call Adam Berger at (202) 334-3756. The Institute of Medicine serves as adviser to the nation to improve health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public. The mission of the Institute of Medicine embraces the health of people everywhere.

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