title: Precision oncology: origins, optimism, and potential.
abstract: Imatinib, the first and arguably the best targeted therapy, became the springboard for developing drugs aimed at molecular targets deemed crucial to tumours. As this development unfolded, a revolution in the speed and cost of genetic sequencing occurred. The result--an armamentarium of drugs and an array of molecular targets--set the stage for precision oncology, a hypothesis that cancer treatment could be markedly improved if therapies were guided by a tumour's genomic alterations. Drawing lessons from the biological basis of cancer and recent empirical investigations, we take a more measured view of precision oncology's promise. Ultimately, the promise is not our concern, but the threshold at which we declare success. We review reports of precision oncology alongside those of precision diagnostics and novel radiotherapy approaches. Although confirmatory evidence is scarce, these interventions have been widely endorsed. We conclude that the current path will probably not be successful or, at a minimum, will have to undergo substantive adjustments before it can be successful. For the sake of patients with cancer, we hope one form of precision oncology will deliver on its promise. However, until confirmatory studies are completed, precision oncology remains unproven, and as such, a hypothesis in need of rigorous testing.
authors: Division of Hematology Oncology, Knight Cancer Institute, Department of Public Health and Preventive Medicine, and Center for Health Care Ethics, Oregon Health and Science University, Portland, OR, USA.
authors: Vinay
authors: V
authors: Prasad
authors: Columbia University and James J Peters Veterans Affairs Medical Center, New York, NY, USA. Electronic address: atf2116@cumc.columbia.edu.
authors: Tito
authors: T
authors: Fojo
authors: Department of Molecular and Clinical Cancer Medicine & Department of Radiation Oncology University of Liverpool Clatterbridge Cancer Centre NHS Foundation Trust Bebington, UK.
authors: Michael
authors: M
authors: Brada
mesh_terms: D006801:Humans; D058990:Molecular Targeted Therapy; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy; D057285:Precision Medicine; D015398:Signal Transduction