title: 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.
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Berliner
authors.affiliation: Technical University of Berlin, 10623 Berlin, Germany ; University of Southern California, Los Angeles, CA, 90089, USA.
authors.forename: Heinz U
authors.initials: HU
authors.lastname: Lemke
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA ; University of Arizona College of Medicine, Tucson, AZ, 85724, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: vanSonnenberg
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: Hani
authors.initials: H
authors.lastname: Ashamalla
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA.
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Mattes
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dosik
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA.
authors.forename: Hesham
authors.initials: H
authors.lastname: Hazin
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: Syed
authors.initials: S
authors.lastname: Shah
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA ; Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: Smruti
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: New York Methodist Hospital, Brooklyn, NY 11215, USA.
authors.forename: Sid
authors.initials: S
authors.lastname: Verma
authors.affiliation: Georgetown University Medical Center, Washington, DC 20007, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.affiliation: University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Bargellini
authors.affiliation: University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Battaglia
authors.affiliation: University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Caramella
authors.affiliation: University Hospital Pisa, University of Pisa (I), 56126 Pisa, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
authors.affiliation: Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Morrison
keywords: Bayesian network; Digital patient model; Hepatocellular carcinoma; Information technology; Model-based medical evidence; Model-guided therapy; Patient-specific model; Personalized medicine; TIMMS; Therapy imaging and model management system