Earlier this month, Inside Precision Medicine hosted its State of Precision Medicine event focused on solutions to advance the widespread adoption of precision medicine globally. Proscia’s Chief Strategy Officer, Nathan Buchbinder, delivered a presentation on why transforming pathology from a qualitative discipline into a scalable, data-driven field is critical for the future of precision medicine. Here are a few highlights from Nathan’s session:
Pathology: The Missing Piece in Precision Medicine
Nathan began by reflecting on Francis Collins’ ambitious vision from 2003, when the former National Human Genome Research Institute Director predicted a “complete transformation of therapeutic medicine” by 2020. While this timeline was optimistic, the progress has been remarkable. In 2023, 38% of FDA-approved drugs were precision treatments, and 66% of drugs approved in 2021 were supported by genomics data.
Most impressive is the impact on patient outcomes: many targeted treatments show response rates upwards of 70% when the relevant biomarker is present.
However, despite this progress, the true revolution in precision medicine has yet to unfold because it has largely been missing the most fundamental window into human disease: pathology. For over a century, pathology has relied on glass slides, microscopes, and manual interpretation. This is particularly striking given that pathology drives 70% of downstream healthcare decisions and spending, and provides the best phenotypic manifestation of disease available. Historically, after diagnosis, glass slides typically end up collecting dust in filing cabinets, their rich data untapped.
Slide presented by Nathan Buchbinder
The Digital Breakthrough
The good news is that we’re now at the beginning of a data revolution that’s fundamentally changing drug discovery and development. Pathology is finally catching up to other data modalities, and the growth trajectory is remarkable.
The initial wave of digital pathology adoption focused primarily on operational efficiency rather than precision medicine. Healthcare providers faced significant challenges that digital pathology could address:
- A growing shortage of pathologists, with each expected to read around 44% more cases than a decade ago
- Difficulties in standardizing interpretations
- Workflow and collaboration inefficiencies across global sites and teams
As digital pathology adoption has grown into the double digits in the US (and even higher in some global regions), the field is now poised to fulfill its true potential to redefine the future of medicine. And that’s because once digital images are created, we have the power to unlock one of the richest sources of biological insight available. As a result, digital pathology can now be used to predict treatment responses and disease progression with unprecedented precision, make precision diagnostics more accessible and affordable, and much more.
Slide presented by Nathan Buchbinder
Explosion in AI—Fueled by Data
Nathan explained how AI is revolutionizing pathology and therapeutic R&D by analyzing vast amounts of complex data to identify previously unknown patterns and provide actionable insights. It accelerates drug development through AI-based biomarkers and companion diagnostics, which are entering clinical trials and clinical care.
Nathan emphasized how AI’s full potential is only accelerating as foundation models have surged in innovation over the past 18 months, significantly improving AI development in pathology and genomics. An example is the ARC Institute’s Evo 2 model, which uncovered unexpected genomic correlations with disease.
AI also unlocks a more holistic characterization of disease with precision, accuracy, and reproducibility, especially when you combine pathology data with other omics data. Nathan explained how the future of medicine is going to come from combining our deep understanding of genomic insights with the messy reality of human phenotypes. The correlation between the clear and the messy, the genomic and the pathology, is creating new insights that give us a better understanding of disease mechanisms and new treatment options.
Use Cases Transforming Precision Medicine
Nathan highlighted four tangible areas where digital pathology and AI are poised to revolutionize precision diagnostics and therapeutics in the near future.
- Advanced Diagnostics for Advanced Therapies: Antibody-drug conjugates (ADCs) require extremely precise quantification of expression levels. AI models can quantify biomarker expression levels, such as HER2-low levels, with exceptional accuracy and reproducibility using digital pathology images.
- Improving Immunotherapy Selection: While therapies like PD-L1 inhibitors have transformed cancer treatment, current assessment methods to determine which patients may benefit are still relatively subjective. AI tools can better quantify expression levels and correlate them with treatment response, improving patient selection.
- AI-Guided Treatment Planning: Beyond bringing new therapies to market, AI-powered digital pathology helps guide decisions about existing treatments, such as identifying which colorectal cancer patients will respond to neoadjuvant chemotherapy.
- Democratizing Access to Precision Diagnostics: Crucially, digital pathology addresses a significant barrier to precision medicine adoption: less than 40% of eligible patients currently receive critical genomic testing like EGFR screening due to cost, time, and accessibility issues. Since pathology is already part of routine diagnostic workflow for cancer patients, AI-based pre-screening performed directly from whole slide images is poised to dramatically impact clinical care by rapidly identifying patients for appropriate genomic testing.
Slide presented by Nathan Buchbinder
Building a Precision Medicine Flywheel
Nathan concluded by emphasizing the need to connect diagnostic practice with life sciences research. As more patients receive digital diagnoses, this de-identified data can drive innovation, support clinical trial recruitment, and accelerate therapy development—creating what he calls a “precision medicine flywheel” where digital pathology in diagnostics fuels research breakthroughs that feed back into improved patient care.
The presentation closed with a reminder of the urgency behind this work. With only 15-45% of patients responding to immunotherapies and seven cancer types still having five-year survival rates below 40%, the need for better precision approaches is clear. “Patients can’t wait,” Buchbinder emphasized, calling for collaboration across pharmaceutical companies, biotechs, CROs, academic researchers, technology companies, and healthcare systems to harness technology, data, and AI to transform patient care.
Want to dive deeper? Watch the full session recording here, or read Proscia’s vision on rewiring pathology with precision medicine to explore these topics further.
Ashley Faber is Director of Product Marketing at Proscia
