COMMENTARY

Curing the Precision Deficit Disorder in Cancer Medicine: Time to Dig Deeper Than Genes?

Andrea Califano, PhD; Gideon Bosker, MD

Disclosures

March 10, 2017

In This Article

Introduction

Precision medicine is emerging as a foundational strategy for cancer treatment. Unlike more conventional, cookbook approaches to therapy, precision medicine relies on customized interventions tailored to the individual patient and the specific tumor. By using advanced sequencing technologies that can determine the presence of mutations in cancer driver genes within a specific tumor—the so-called "driver" mutations—and by applying this information to selecting targeted drugs shown to be effective for specific mutations, cancer specialists are able to match tumors with therapies to which they are most likely to respond. Based on the premise that one drug does not fit all tumor types and targets, the precision-focused paradigm is trying to use objective data, in consideration of the tumor's DNA sequence, to make informed decisions about therapeutic options.

Precision medicine is under attack.

Despite the many documented successes of precision medicine and the inevitability of its pivotal role in the future of cancer treatment, many within the medical profession have begun to question the wisdom and value of this strategy. Whether the approach is based on the identification of mutations that can be targeted with a new generation of drugs or uses drugs that activate the immune system to bolster the body's defenses against cancer cells, precision medicine is under attack.

In fact, a recent article by Drs. Ian Tannock and John Hickman in the New England Journal of Medicine, one of the world's leading journals for clinical medicine in which seminal advances are frequently published, portrays targeted cancer therapy as an overall failure.[1] The takedown of precision medicine in the press has been compounded by other reports in cancer journals as well as the lay press, where caution against the toxicity associated with immunotherapy has been highlighted as a deterrent to its deployment.

Far from signaling the demise of precision medicine, these extreme views reflect a lack of understanding of cancer as a complex disease. Equally problematic, they are being given greater voice by the media, where an otherwise relevant public conversation about precision cancer medicine is caught up in a seesaw of conflicting reports that juxtapose claims of astonishing successes with those of irremediable failures. In this age of "facts" and "alternative facts," where do the so-called facts lie with respect to precision cancer medicine?

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