Model-guided therapy for hepatocellular carcinoma: a role for information technology in predictive, preventive and personalized medicine

Abstract

Predictive, preventive and personalized medicine (PPPM) may have the potential to eventually improve the nature of health care delivery. However, the tools required for a practical and comprehensive form of PPPM that is capable of handling the vast amounts of medical information that is currently available are currently lacking. This article reviews a rationale and method for combining and integrating diagnostic and therapeutic management with information technology (IT), in a manner that supports patients through their continuum of care. It is imperative that any program devised to explore and develop personalized health care delivery must be firmly rooted in clinically confirmed and accepted principles and technologies. Therefore, a use case, relating to hepatocellular carcinoma (HCC), was developed. The approach to the management of medical information we have taken is based on model theory and seeks to implement a form of model-guided therapy (MGT) that can be used as a decision support system in the treatment of patients with HCC. The IT structures to be utilized in MGT include a therapy imaging and model management system (TIMMS) and a digital patient model (DPM). The system that we propose will utilize patient modeling techniques to generate valid DPMs (which factor in age, physiologic condition, disease and co-morbidities, genetics, biomarkers and responses to previous treatments). We may, then, be able to develop a statistically valid methodology, on an individual basis, to predict certain diseases or conditions, to predict certain treatment outcomes, to prevent certain diseases or complications and to develop treatment regimens that are personalized for that particular patient. An IT system for predictive, preventive and personalized medicine (ITS-PM) for HCC is presented to provide a comprehensive system to provide unified access to general medical and patient-specific information for medical researchers and health care providers from different disciplines including hepatologists, gastroenterologists, medical and surgical oncologists, liver transplant teams, interventional radiologists and radiation oncologists. The article concludes with a review providing an outlook and recommendations for the application of MGT to enhance the medical management of HCC through PPPM.

The Ethanol Supernatant Extracts of Liushenwan Could Alleviate Nanodiethylnitrosamine-Induced Liver Cancer in Mice

“…However, a so-called “best” choice for patients with HCC could be quite hard [ 4 ]. Thus, alternative agents with better efficacy and less detriment for the management (prevention and treatment included) of HCC are urgently needed [ 5 ].…”

Systematic revelation of the protective effect and mechanism of Cordycep sinensis on diethylnitrosamine-induced rat hepatocellular carcinoma with proteomics

“…In spite of current advances in the use of synthetic drugs, several shortcomings such as efficacy and side effects still remain [ 2 ]. Thus, there is an urgent need for alternative and effective agents for the management of hepatocellular carcinoma, with better efficacy and less detriment [ 3 ]. The major causes of HCC are known as hepatitis B or C virus infection and alcohol exposure [ 4 , 5 ].…”

Patients with hepatic breast cancer metastases demonstrate highly specific profiles of matrix metalloproteinases MMP-2 and MMP-9 after SIRT treatment as compared to other primary and secondary liver tumours

“…The matter is hardly explainable by currently available diagnostic and prognostic tools. An approach to achieving greater understanding of the wide variation in biologic activity and patient-specific response to therapy utilising an Information Technology framework, with respect to hepatocellular cancer, has been recently proposed [ 16 , 17 ]. Work is currently underway in understanding variability in individual responses through data-mining utilising graph theory and Bayesian inference.…”