Embracing the Complexity of Cancer: Seeing the Forest and the Trees

Personalized medicine is transforming biomedical research and healthcare service delivery. Disease definition, diagnosis, treatment, and prevention are being fundamentally altered by the capacity to routinely perform comprehensive molecular characterization. Nowhere is this change happening faster than in the field of cancer. Increasingly sophisticated technology provides the capacity to describe, in multiple molecular dimensions, the tumor and the individual in which it has developed. These technologies identify the millions of variants present in normal individuals and thousands of alterations that occur during the course of the disease process. This systems-wide molecular analysis of constitutional and somatic tissues has identified a complex cacophony of inherited and acquired variation. Coherence emerges from these data when evaluated using biologic networks as analytic frameworks. These networks account for the individual heterogeneity in underlying etiology as well as the diversity of events necessary to generate a complex phenotype such as cancer. Emerging collections of analytic approaches permit analysis using genome-wide data sets and established biologic networks as models. The generation of this unprecedented amount of data presents us with the challenge contextualizing that data and converting into actionable information. The integration and interpretation of this complex multidimensional information into the evidence necessary to support clinical care exceeds the raw human cognitive capacity. Information systems have the capacity to provide the needed "tool" to tackle this challenge - to generate the necessary evidence to support the delivery of personalized medicine. Arizona State University's (ASU) Complex Adaptive Systems team is building such an Evidence Engine in its Next Generation Cyber Capability (NGCC). The ASU NGCC - composed of networks, hardware, software, and people transforms "Big Data" to information and creates the evidence necessary to enable personalized medicine.