Sean Khozin, Geoffrey Kim & Richard Pazdur in Nature: “….Recent advances in our understanding of disease mechanisms have led to the development of new drugs that are enabling precision medicine. For example, the co-development of kinase inhibitors that target ‘driver mutations’ in metastatic non-small-cell lung cancer (NSCLC) with companion diagnostics has led to substantial improvements in the treatment of some patients. However, growing evidence suggests that most patients with metastatic NSCLC and other advanced cancers may not have tumours with single driver mutations. Furthermore, the generation of clinical evidence in genomically diverse and geographically dispersed groups of patients using traditional trial designs and multiple competing therapies is becoming more costly and challenging.
Strategies aimed at creating new efficiencies in clinical evidence generation and extending the benefits of precision medicine to larger groups of patients are driving a transformation from a reductionist approach to drug development (for example, a single drug targeting a driver mutation and traditional clinical trials) to a holistic approach (for example, combination therapies targeting complex multiomic signatures and real-world evidence). This transition is largely fuelled by the rapid expansion in the four dimensions of biomedical big data, which has created a need for greater organizational and technical capabilities (Fig. 1). Appropriate management and analysis of such data requires specialized tools and expertise in health information technology, data science and high-performance computing. For example, efforts to generate clinical evidence using real-world data are being limited by challenges such as capturing clinically relevant variables from vast volumes of unstructured content (such as physician notes) in electronic health records and organizing various structured data elements that are primarily designed to support billing rather than clinical research. So, new standards and quality-control mechanisms are needed to ensure the validity of the design and analysis of studies based on electronic health records.
Big data can be defined as having four dimensions: volume (data size), variety (data type), veracity (data noise and uncertainty) and velocity (data flow and processing). Currently, FDA approval decisions are generally based on data of limited variety, mainly from clinical trials and preclinical studies (1) that are mostly structured (2), in data sets usually no more than a few gigabytes in size (3), that are processed intermittently as part of regulatory submissions (4). The expansion of big data in the four dimensions (grey lines) calls for increasing organizational and technical capacity. This could transform big data into smart data by enabling a holistic approach to personalization of therapies that takes patient, disease and environmental characteristics into account. (Full size image (309 KB);Download PowerPoint slide (492 KB)…More)”