Despite tremendous progress in research and bioinformatics, we are still using antiquated tools to evaluate and treat our patients that resemble what we employed more than a century ago. The way physicians interact with patients has not kept pace with the immense wealth of information that theoretically should be at our fingertips. We still compile a picture of health and disease in an idiosyncratic, impersonal, and incomplete way—not unlike if one were to feel only an elephant's trunk or tail and try to make a determination about the entire animal.
While we certainly play a role in perpetuating this system, physicians are not entirely to blame. We do not have what we need in order to take full advantage of the knowledge gleaned over the last nearly half-century of the molecular features of disease.
The fact is that we as health care practitioners and diagnosticians lack the analytical technologies that would permit us to organize and categorize the vast amounts of data that are potentially relevant to the care of our patients in any meaningful way. Furthermore, in a clinical setting even well-organized data is useless unless we can instantaneously link it back to the patient to make a personalized, evidence-based treatment decision.
To move down the path towards personalized medicine, we need a tool that helps create order out of the chaotic realm that is biological data, including all the “omics” information: genomics, proteomics, metabolomics, methylomics, and transcriptional profiling of tumors and normal tissues.
This tool should be secure, comprehensive, and self-contained, while at the same time connected to multiple data sets housed in libraries, tissue banks and databases scattered throughout the cancer research universe. Finally, and perhaps most importantly for those of us who see patients, this tool must be intuitive and user-friendly enough to help guide our decisions quickly and efficiently.
At Georgetown Lombardi Comprehen sive Cancer Center, we recently launched the Georgetown Database of Cancer, or G-DOC, a platform we believe has the potential to provide the answers we have been seeking.
Under development for the past two years by a team led by Georgetown bioinformaticians, G-DOC is a single website portal that integrates molecular and clinical cancer data into an easily searchable—but entirely secure—platform. Our goal is to continually enrich and expand the information accessible in G-DOC by having cancer researchers submit their data sets, and by gaining permission from patients treated at Georgetown Lombardi and our collaborating institutions to have their treatment history anonymously entered into the system.
G-DOC also draws on external databases and analytic resources, but the advantage is that everything is in one place and is stored in compatible formats that are retrievable for the integrated analysis of multiple data sets.
Launched October 26th, G-DOC represents the first clinically operational step forward in a paradigm shift under way at Georgetown University Medical Center to adapt a “systems medicine” approach for medical care, research, and education. Systems medicine will allow health care providers to understand the interplay between genetics and the environment in such a way that one day, they will be able to predict who is at greatest risk, rather than simply react to symptoms.
G-DOC is currently accessible to all researchers and clinicians at Georgetown, but our hope is to open it for use in the broader community sometime in 2011.
Our pilot projects are in breast and colorectal cancer, and we have already entered data on several thousand patients who have consented to participate in clinical research. The data sets include molecular information as well as detailed clinical outcomes and patient questionnaires on lifestyle and risk factors.
G-DOC enables the user to generate customizable reports comparing patient cohorts that can be saved, printed, or shared with colleagues. The utility of these data sets will only continue to grow as researchers add new information.
After years of conception and planning followed by two years of intense labor by the team that built it, the process of perfecting G-DOC is ongoing and likely to be never-ending. But this effort has resulted in a product that has more than exceeded my hopes and expectations. We have met—and will continue to meet—an unprecedented challenge and opportunity head on.
As physicians and researchers, we frequently use the phrase “personalized medicine,” but we don't necessarily have a clear path for how to get there. We know that detailed molecular information exists in abundance, but information in and of itself is not the same as power when we have no way to make sense of the information. I view G-DOC as a critical step towards this ideal of truly personalized medicine.
This is a tool that enables us to concretize vast amounts of information into knowledge, and to then convert that knowledge into the power to provide the best possible care for our patients.
In the 21st century, with everything we now know about health and the causes and molecular bases of human diseases, to provide anything less is simply not acceptable.