title: Precision Medicine in Gastrointestinal Pathology.
abstract: BACKGROUND
  -Precision medicine is the promise of individualized therapy and management of patients based on their personal biology. There are now multiple global initiatives to perform whole-genome sequencing on millions of individuals. In the United States, an early program was the Million Veteran Program, and a more recent proposal in 2015 by the president of the United States is the Precision Medicine Initiative. To implement precision medicine in routine oncology care, genetic variants present in tumors need to be matched with effective clinical therapeutics. When we focus on the current state of precision medicine for gastrointestinal malignancies, it becomes apparent that there is a mixed history of success and failure.
  
  
  OBJECTIVE
  -To present the current state of precision medicine using gastrointestinal oncology as a model. We will present currently available targeted therapeutics, promising new findings in clinical genomic oncology, remaining quality issues in genomic testing, and emerging oncology clinical trial designs.
  
  
  METHODS
  -Review of the literature including clinical genomic studies on gastrointestinal malignancies, clinical oncology trials on therapeutics targeted to molecular alterations, and emerging clinical oncology study designs.
  
  
  CONCLUSIONS
  -Translating our ability to sequence thousands of genes into meaningful improvements in patient survival will be the challenge for the next decade.
authors.forename: David H
authors.initials: DH
authors.lastname: Wang
authors.affiliation: From the Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas (Dr Wang);|and the Department of Pathology, Eugene McDermott Center for Human Growth and Development, Children's Medical Center, and University of Texas Southwestern Medical Center, Dallas (Dr Park).
authors.forename: Jason Y
authors.initials: JY
authors.lastname: Park
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000737:chemistry / Q000235:genetics / Q000378:metabolism; D002986:Clinical Trials as Topic; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D041981:Gastrointestinal Tract / Q000187:drug effects* / Q000378:metabolism; D006291:Health Policy / Q000639:trends; D006801:Humans; D008969:Molecular Sequence Data; D058990:Molecular Targeted Therapy / Q000009:adverse effects / Q000639:trends; D009154:Mutation; D009363:Neoplasm Proteins / Q000737:chemistry / Q000235:genetics / Q000378:metabolism; D010338:Pathology, Clinical / Q000379:methods* / Q000639:trends; D000071185:Pharmacogenomic Testing / Q000592:standards / Q000639:trends; D057285:Precision Medicine / Q000639:trends; D011379:Prognosis; D011787:Quality of Health Care; D012107:Research Design
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins