Precision oncology: neither a silver bullet nor a dream

Area of Science:

• Oncology
• Genetics
• Pharmacology

Background:

• Precision oncology aims to tailor cancer treatments based on individual genetic profiles.
• It emerged as an alternative to traditional 'one-size-fits-all' approaches.
• Current evaluation methods for large-scale trials may not suit precision oncology's smaller-scale studies.

Purpose of the Study:

• To advocate for the integration of precision oncology successes into clinical practice.
• To redefine expectations for precision oncology's role in cancer treatment.
• To highlight the need for revised clinical trial designs and endpoint measurements for precision oncology.

Main Methods:

• Review of existing data on targeted therapies and genetic aberrations.
• Analysis of the limitations of conventional clinical trial designs for precision oncology.
• Discussion of the necessity for new evaluation metrics tailored to precision oncology.

Main Results:

• Identified specific genetic targets (e.g., ABL, ALK, BRAF, BRCA1/2, EGFR, KIT, KRAS, PDGFRA/B, FLT3, ROS1) with FDA-approved drugs, demonstrating Level 1 evidence.
• Highlighted that current trial evaluation tools are inadequate for precision oncology.
• Emphasized that most targeted therapies are in early stages, with combination therapies potentially crucial for future success.

Conclusions:

• Precision oncology is a valuable tool, not a universal cure for cancer.
• Successful integration requires realistic expectations and adaptation of clinical trial methodologies.
• Further research into combination therapies is essential to fully realize precision oncology's potential.