title: Cancer genomics: the challenge of drug accessibility.
abstract: OBJECTIVE
  Although significant strides have been made in genome sequencing technology, target-drug matching remains challenging. This article highlights the difficulties associated with patients accessing targeted drugs based on genomic information, and some proposed solutions.
  
  
  RESULTS
  Although cancers are increasingly stratified according to molecular subgroups, challenges remain in improving patient outcome based on drug-target matching. Before a drug-target match is even proposed, significant expertise is required of the clinician to interpret genomic information. Once a potential match is made, barriers remain for patients to access treatment via clinical trials, as approved agents on-label or off-label, or through expanded access programs. Solutions to improve drug accessibility are actively being investigated. Several prospective trials using molecular characterization as an entry to access target-drug matching are underway. For those unable to access target-drug matching on trial, proposals for a facilitated access program and registry have been suggested.
  
  
  CONCLUSIONS
  Although improvements have been made in the drug development and approval timelines, drug accessibility based on molecular characterization remains problematic. However, with the emergence of novel trial designs, and efforts to enhance drug access outside of clinical trial settings, opportunities for drug-target matching are improving.
authors.affiliation: Bras Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lewin
authors.forename: Lillian L
authors.initials: LL
authors.lastname: Siu
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics / Q000600:supply & distribution; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D017277:Drug Approval; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D056687:Off-Label Use / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
chemical_list: D000970:Antineoplastic Agents