Precision Medicine in the Universal Healthcare System in the Netherlands

A: The Netherlands, a country with approximately 17 million people, has a typical socialized healthcare system, i.e. equal access to state-of-the-art medical care for all Dutch citizens, including but not limited to oncological care. This healthcare system was the basis for a rather unique effort towards precision molecular oncology. While molecular tumor boards were being established, a Nationwide initiative started in 2014, named Centre for Personalized Cancer Treatment (CPCT). Physicians can enroll patients in CPCT in 50 medical centers in The Netherlands, including all academic cancer centers. Cancer biopsies, preferably from metastatic sites are snap frozen and sent to a centralized state-of-the-art sequencing facility that was made possible via a donation of the Hartwig Medical Foundation. In case actionable mutation(s) are identified, targeted treatments can be prescribed, which is enabled/specified in the Drug Rediscovery Protocol (DRUP). Methodological concerns around Next Generation Sequencing (NGS) such as, quality of tumor specimen, standardized operating procedures (CLIA/ ISO certified laboratory), bioinformatics’ pipelines for mutation calling, and physician reporting are all addressed. Around 2,000 patients have been enrolled, and we are awaiting results from this unique effort to systematically introduce NGS-based DNA analysis into clinical practice. I believe the CPCT approach is the way forward. However, we should realize that this is only the first step towards precision medicine. One improvement is straight forward: molecularly characterize the cancer as early as possible since clonal heterogeneity is a well-described complicating factor in the treatment of this disease. We should not ignore it in our treatment concepts (i.e. combination treatment). In addition to epigenetic changes, changes in gene and protein expression harbor the key to molecular classification of cancers as basis for rationalized treatment. I will keep you informed on CPCT’s progress at CollabRx.com.