Functional precision cancer medicine—moving beyond pure genomics
By Anthony Letai, MD, PhD | Nature Medicine
(Complete article here)
The essential job of precision medicine is to match the right drugs to the right patients. In cancer, precision medicine has been nearly synonymous with genomics. However, sobering recent studies have generally shown that most patients with cancer who receive genomic testing do not benefit from a genomic precision medicine strategy. Although some call the entire project of precision cancer medicine into question, I suggest instead that the tools employed must be broadened. Instead of relying exclusively on big data measurements of initial conditions, we should also acquire highly actionable functional information by perturbing—for example, with cancer therapies—viable primary tumor cells from patients with cancer.
‘Precision medicine’ is a hot phrase these days—its use has gone beyond the biopharmaceutical and academic medical center communities into the lay press and political discourse.
Everyone agrees that it is a good thing and that more of it is needed. However, it is important to understand what is meant by precision medicine if investment in it is going to be increased. For the purposes of this Perspective, I define precision medicine as the process of matching an individual patient with the medicines that are best for them using any method. In cancer precision medicine, this usually means identifying the treatment(s) that will best decrease tumor size or eradicate the patient’s cancer.
How has precision cancer medicine been doing recently? Many new initiatives have embraced it, including the US federal government’s 2016 Precision Medicine Initiative, as well as the Cancer Moonshot effort championed by former Vice-President Joe Biden. Most major cancer centers have an institutional precision medicine program. However, some investigators have expressed grave concerns about the use of precision medicine in cancer treatment, responding to recent reports of precision medicine trials demonstrating a level of patient benefit that is disappointingly low1–6. Given the significant public and private investment in precision cancer medicine, this seems to be a good time to examine what tools have been used in precision cancer medicine, what results have been obtained, and what opportunities there are for improving precision cancer medicine in the future…..(read more)