On September 16, ILD Day, we’ll be hearing about “precision medicine” and interstitial lung disease (ILD), but what is precision medicine?

The National Institutes of Health defines “precision medicine” as “the right treatment for the right patient at the right time”. One of the most recognizable examples of this is seen in the change in lung cancer care over the past several decades. In the past, treatment decisions were largely made on the stage of the lung cancer, or how far it had spread at the time of diagnosis and involved mostly chemotherapy medicines with systemic toxicities. However, much is now known about the biology of different lung cancers and the molecular mechanisms that drive growth and spread, which has led to the development of anti-tumor immune therapies and tumor-specific treatments based on the results of molecular tests (a type of “biomarker”) performed on biopsy tissue. These more targeted treatments, combined with screening programs in high-risk individuals, have begun to improve survival in one of the deadliest types of cancer.

The diagnosis and treatment landscape of ILD is also becoming more precise over time, with more detailed diagnostic guidelines, recognition of the “progressive pulmonary fibrosis” (PPF) process, improved management of associated medical conditions, such as pulmonary hypertension, and better-defined roles for antifibrotic and immunosuppressive therapies. However, the way we define diagnoses fails to capture the differences in biology that lead to and drive the disease process, and the more we learn, the more questions arise:

• In families affected by PF, can we predict which family members will develop disease, and which will not?
• In patients with risk factors for ILD, such as those with occupational exposures or systemic autoimmune related diseases (SARD), why do some people develop ILD but others do not?
• How can one person with idiopathic pulmonary fibrosis (IPF) live for years with limited symptoms while another has aggressive disease with rapid progression? Can this be predicted at the time of diagnosis?
• Why does one patient with systemic sclerosis (SScl) develop a more inflammatory ILD and another a more fibrotic ILD?
• Why do some patients with ILD develop pulmonary hypertension (PH) while others do not?

Researchers are beginning to answer these questions by deploying new analytic techniques, involving machine learning, and utilizing large real-world data sets, such as the PFF Registry. The Prognostic Lung Fibrosis Consortium (PROLIFIC) has developed a blood test-based risk score for use in clinical trials. The Prospective Treatment Efficacy in IPF Using Genotype for NAC Selection (PRECISIONS) project included not only the first “pharmaco-genomic” study of IPF, but it also supported more than 40 investigations using genetic and molecular analyses of blood samples to separate more clearly the biology of IPF from other types of ILDs and to use these types of investigations to predict both disease progression and treatment response. More studies like this are underway, including Prospective phenotypic and Multi-omic Endotyping of Progressive Pulmonary Fibrosis (PRIME-PPF), which aims to develop prediction criteria for development of progressive fibrosis, and Metformin to Attenuate progressive Respiratory decline in IPF (MAVRIC), which will use a novel blood test to screen for high risk patients to enroll into a clinical trial.

While these newer tests and technologies are still experimental, more is being learned every day. I’m excited to learn more about how precision medicine may change the care of patients with ILD in the future! Join us for the conversation and free webinar, Personalizing ILD Medicine: The right treatment for the right patient, on Wednesday, September 16, at 12 p.m. CT.