Dear Yaying Pan

Personalized medicine helps oncologists choose the right cancer treatment based on the genetic makeup of the tumor. With this technique, the doctor can analyze the cancer cells to witness any protein or gene changes so that the best treatment that will work perfectly may be selected. The molecular characteristics of the tumor can be understood while accurately determining the stage and type of cancer. In some cases, even sub-types of cancer are identified for curating an effective treatment plan.

The main benefit of personalized medicine is that it helps in studying specific gene changes or mutations occurring in cancer cells. In most cases, cancer develops when DNA in healthy cells mutate and grow uncontrollably. The gene changes associated with the progression and development of cancer are understood so that a tailored treatment plan can be advised.

So, personalized medicine can help in 1) better disease prevention by utilizing genetic testing and other advanced diagnostics to identify individuals at higher risk for specific diseases, allowing for proactive interventions and preventative measures; 2) improved diagnosis by considering individual genetic and environmental factors, leading to more accurate diagnoses and appropriate treatment initiation; 3) more effective treatments by selecting treatments that are most likely to be effective for a specific patient, based on their individual characteristics leading to better treatment outcomes and reduced side effects; 4) reduced healthcare costs by preventing diseases, improving diagnosis, and selecting the most effective treatments, one can minimize the need for costly hospitalization.

Regards,

Malcolm Nobre

One simple fact patients with pancreatic adenocarcinoma with mutations of gene SMAD-4 do not respond to folfirinox therapy and need gencitabine based tereatment in neoadjuvant therapy or adjuvant therapy

Non-small cell lung cancer (NSCLC) presents an en example of a significant impact of precision medicine in oncology. Historically, the first-line treatment for advanced NSCLC was uniformly based on chemotherapy, with or without anti-angiogenic agents. During this era, therapeutic outcomes were modest, with median progression-free survival (mPFS) and median overall survival (mOS) typically measured in months, underscoring the limitations of conventional cytotoxic regimens.

In contemporary practice, the management of NSCLC—particularly non-squamous subtypes—has shifted toward molecularly guided strategies. Comprehensive genomic profiling now enables the identification of actionable oncogenic drivers, including sensitizing EGFR mutations, ALK and ROS1 rearrangements, RET fusions, BRAF V600E mutations, MET exon 14 skipping mutations, and NTRK fusions. Each of these alterations delineates a distinct molecular subset of NSCLC, facilitating a precision oncology approach. Patients harboring these alterations are treated with targeted therapies, primarily tyrosine kinase inhibitors (TKIs), which have demonstrated superior efficacy in clinical trials, significantly improving mPFS and mOS—in some cases extending survival to several years.

For patients without targetable driver mutations, immune checkpoint inhibitors (ICIs), either as monotherapy or in combination with chemotherapy, represent a standard first-line option when clinically appropriate. Additionally, emerging targets such as ERBB2 (HER2) mutations and KRAS G12C mutations have expanded the therapeutic landscape, with targeted agents now recommended as second-line options for eligible patients.

In summary, the treatment paradigm for advanced non-squamous NSCLC has evolved from a uniform, chemotherapy-based approach to a highly stratified framework encompassing at least eight molecularly defined subsets, each with distinct targeted therapies. This shift has not only redefined NSCLC as a heterogeneous group of diseases but has also substantially improved patient outcomes, offering survival benefits far exceeding those achievable with traditional chemotherapy.

Very very important thought.. all cancers need personalised treatment on background of resources, life expectancy and stage .Specially now gene markers and molecular biology of tumor should also have place in treating cancers of colorectal and pancreas