Time after time, the marketing team from pharmaceutical companies bring us some pearls like 'target therapy', to differentiate their drugs from chemotherapy (which in fact they are a class of), or ´personalized medicine´, to emphasize some predictive factor favoring a new treatment in detriment of older ones (the search for the holy graal is permanent).

Indeed, science permited us to achieve a better understanding of cancer diseases and some new therapies emerged, at a high cost due to the vast failure in translate biological knowledge into useful drugs. Meanwhile, if a drug is not 'patentable', as metformin, the system will not provide funds enough to fully appreciate its therapeutical role in a timely manner, no matter how sound would be its background (unless a slightly modified version of the ancient drug could be produced).

About your question, marketing apart, medicine always was and must be about care a person, its fears, beliefs, habits, organism and his/her disease. At every consultation and prescription, an oncologist should 'personalize' the approach to diagnosis and treatment for that single patient - and not to abstract the patient singularity to apply blindly the newest true 'discovered' in the scientific noise from medical literature.

For sure there are challenges in implementing personalized medicine, including drug development, regulation, cost, etc.  Some practical benefits of personalized medicine, if properly implemented would  not only be targeted therapy against a specific "actionable target" of individual's illness but the optimization of the therapy to maximize response and decrease side effects. I think one of the flaws of monotherpy with one drug fits all mentality of the past is that dosage and response are estimated based on trials in small groups of people (relative to population). This means some people will not respond to certain drugs or have extreme side effects. Worse perhaps is many drugs approved for adult use were trickled down into paediatrics based on mostly if not exclusively adult clinical trials. Perhaps a little optimistically, I think once we have a much better understanding of the relationship between (epi)genetics, disease and drug metabolism on an individual basis, personalized medicine will become more personalized and more practical.

One great example of Personalized Medicine in Oncology is HERCEPTIN/Trastuzumab- a monoclonal antibody for breast cancer. It works on only 20-25% patients, where Her-2/neu gene is over-expressed. Otherwise, breast cancer patients are advised by oncologists to seek other approved/prescribed treatment options.....I understand that the price is quite often prohibitive for such customized treatments?

We need a better understanding of (epi) genetic changes inside the tumor, its micro-environment, stage of tumor development , cancer stem cell profile, and probable toxicity of the prescribed drug? Better solutions will come once we co-relate (bioinformatically)- toxicogenomics with pharmacogenomics as well as know the precise genetic profile of tumor cells? We have to tailor the treatment with the tumor gene profile of each individual, instead of pharmaceutical industry model of "one-size-fits-all"......

Time after time, the marketing team from pharmaceutical companies bring us some pearls like 'target therapy', to differentiate their drugs from chemotherapy (which in fact they are a class of), or ´personalized medicine´, to emphasize some predictive factor favoring a new treatment in detriment of older ones (the search for the holy graal is permanent).

Indeed, science permited us to achieve a better understanding of cancer diseases and some new therapies emerged, at a high cost due to the vast failure in translate biological knowledge into useful drugs. Meanwhile, if a drug is not 'patentable', as metformin, the system will not provide funds enough to fully appreciate its therapeutical role in a timely manner, no matter how sound would be its background (unless a slightly modified version of the ancient drug could be produced).

About your question, marketing apart, medicine always was and must be about care a person, its fears, beliefs, habits, organism and his/her disease. At every consultation and prescription, an oncologist should 'personalize' the approach to diagnosis and treatment for that single patient - and not to abstract the patient singularity to apply blindly the newest true 'discovered' in the scientific noise from medical literature.

Is there a practical benefit of personalized medicine in oncology care? I think the trial recently published in JAMA "Association of aspirin and NSAID use with risk of colorectal cancer according to genetic variants" is a good example. For a while it has been known that Aspirin and other NSAIDS can reduce colorectal cancer risk. Nevertheless, despite these drugs are relatively inexpensive, its use comes at a cost i.e. GI bleeding, etc.... Hence, identifying individuals who will benefit the most will allow us to develop personalized cancer prevention strategies

I think that the concept personalised medicine would benefit from a more uniform definition. At present it can have at least three different interpretations

1) from the care perspective treating each patient as a unique human being

2) from a disease perspective attacking specific biological targets

3) from a phenotypic perspective adapting therapy to individual genotypic/phenotypic characteristics in individual patients

I would favor reserving personalised medicine for the latter interpretation. One good example of this is the adaption of 6-mercaptopurin therapy to the TPMT genotypic status in children wuth acute lymphoblastic leukaemia.

We think it is at first necessary declaring a new goal-orientated anti cancer strategy as we did by differentiating in detail into a personalized and individualized approach:

Imagine A World Without Cancer

BMC Cancer 2014; 14: 186: 1-8.

http://www.biomedcentral.com/1471-2407/14/186

If this would be realized we would be going into the direction of a real precised medicine. Until than it will be a scratch on the surface.

Furtherit is needed in cancer identifying the cause. It makes no sense, that a war against cancer was declared in 1972 but soldiers were sent into a battle without knowing the enemy.

Reality is that cancer is triggered in 

1) 5-10% by mutation

2) 15% by infection and

3) 80% are sporadic, meaning "unknwon cause".

Therefore we recommend concentrating on the identification of the cause of the mass of cancers first. For this we proposed - from our perspective - a much more plausible cancer paradigm together with deeper biochemical and pathophysiological explanations:

“Epistemology of the Origin of Cancer: a new paradigm"

BMC Cancer 2014; 14:331: 1-8:

http://www.biomedcentral.com/1471-2407/14/331

“Cell-Cell Communication in the Tumor Microenvironment, Carcinogenesis, and Anticancer Treatment"

Cell Physiol Biochem 2014; 34: 213-243: 

http://www.karger.com/Article/FullText/362978

Mabe a bit more convenient way for faster reading, an article by James Grundvig in EpochTimes:

A New Understanding Of The Cause Of Cancer

http://www.theepochtimes.com/n3/753288-a-new-understanding-of-the-cause-of-cancer/?photo=4

http://www.biomedcentral.com/1471-2407/14/331

http://www.karger.com/Article/FullText/362978

http://www.biomedcentral.com/1471-2407/14/186

@Bjorn

I by no means think that all cancers are caused by mutations, and it is likely that mutations found in late-stage cancers may not have been the cause of the cancer but I would contest the distribution you mentioned in your answer:

"Reality is that cancer is triggered in 

1) 5-10% by mutation

2) 15% by infection and

3) 80% are sporadic, meaning "unknwon cause"."

I would consider cancers to be of two types, sporadic or familial.  I assume that by the 5-10% that you refer to caused by mutation, that you are actually referring to familial cancers such as those of cancer predisposition syndromes in which germline mutations confer an increased susceptibility to the disease such as Neurofibromatosis, Li-Faumeni syndrome, Gorlin syndrome, etc. 

I understand sporadic cancers to be all of the rest that are not caused by inherited susceptibilities, irrespective of whether they are caused by viral infection, "unknown cause" or somatic mutations. There are definitely sporadic cancers which are driven by somatic events in oncogenes/tumour suppressors, those associated with viral infections and those that appear to be of an "unknown cause".

Thanks Pawel.

I suggest readig the papers I provided, anything is clarified within those.

Treatment with targeted therapy has improved outcomes for some diseases. Imatinib has had an excellent effect on chronic myeloid leukemia, and sunitinib, rituximab,trastuzumab and ipilimumab have revolutionized the treatment of renal cell carcinoma, non-Hodgkin’s lymphoma, breast cancer, and metastatic melanoma respectively . In other instances, the degree of clinical benefit is more modest. In patients with advanced pancreatic cancer, the addition of erlotinib to standard chemotherapy increases the one-year survival rate from 17 to 24 percent, which correlates to an increase in median survival from 24 to 27 weeks

To achieve the goal of personalized medicine it is necessary not only to have agents with defined molecular specificities, but to have minimally invasive biomarker and imaging tests that will identify which patients have the target in their tumor and the patient’s pharmacogenotype.

http://omicsgroup.org/journals/targeted-therapy-in-oncology-a-key-player-in-the-move-towards-personalized%20medicine-2329-6631.1000e116.php?aid=9403

Imatinib story is a great example.

In addition, it is not only about efficacy of the drug - it is also about the side effects.

I would agree with Jonas in this thread. Personalized medicine is most relevant here in the genomic space. Not only the genetic makeup of the individual, but, the expression of individual genes (regulated through epigenetics) which add an additional layer of complexity to the "personilzed medicine" realm. When we start incorporating data generated from single cells and begin identifying commonalities in transformed cells then we can truly start looking at individual or personalized therapies.

If you think about radiotherapy, this is obviously one of the most personalized treatments, with an individually planned radiation exposure concentrated on the tumour tissue. This is even progressively improved with novel administration techniques and radiation qualities.

W.

Targeted-therapy-in-oncology-a-key-player-in-the-move-towards-personalizedmedicine

Personalized medicine, 'patient centered care' is a must in clinical care, otherwise, patients will notice they go worse with you than with other practitioners, that the death rate with you looks worse, and not only will begun running away from your office, but can sue you.

Adjusting to 'Lex artis' is mandatory. Agur. Salut +