Busting myths about precision oncology and personalized cancer treatments

Cancer patients often confuse ‘personalized cancer medicine’ and ‘personalized cancer treatments’.

Due to the over-the-top advertorial firepower of few pharma companies, ‘personalized cancer medicine’ often gets oversold, and patients start believing that one-size ‘magic pills’ can help them in combating cancer. In reality, what they need is a personalized cancer treatment.

In an exclusive feature on Nature magazine^[1], Dr Leonard Saltz described his experience of dealing with patients who had seen television programs about precision oncology, about one-off cases where targeted therapies had been administered as pills to make tumors ‘disappear’. These patients and their families would often call Dr Saltz and ask if the same thing could be done for their cancer treatment. Dr Saltz regrets that patients think of such ‘one-pill’ miracles as precision oncology –

“That’s what people think precision oncology is. And, gosh, I wish that were so.”
–Dr Leonard Saltz (Memorial Sloan Kettering Cancer Center, New York)

What is precision oncology?

Precision oncology is defined^[2] as the “molecular profiling of tumors to identify targetable alterations”. It has undergone rapid advancements in recent years, and is now a part of mainstream clinical practice. In precision oncology, once a tumor piece has been retrieved, it is put through coordinated genomic testing to produce high-quality tissue samples. These tissue samples are then sent to next-generation sequencing (NGS) labs for molecular analysis, based on which a targeted treatment can be planned.

Results achieved through precision oncology are often deemed ‘miraculous’ because they are effective against extremely aggressive types and stages of cancer. But most oncologists insist that these are very rare scenarios. Also, it takes a huge amount of resources, both in terms of manpower and research-level funding, to enable the right precision oncology trials.

The problem in rebranding ‘precision oncology’ as ‘personalized cancer medicine’

Throughout history, new and potentially ‘breakthrough’ cancer treatments have attracted the attention of cancer patients in advanced stages, and their families. This ‘perception’ often runs ahead of reality, and promising results get mistaken for sureshot remedies. Yes, precision oncology is promising. But the promotional efforts of marketing such treatments under the simple label of ‘personalized cancer medicine’ is a dangerous practice, as it yields misinformed treatment decisions.

Many clinicians say that the media has painted a much rosier picture of miracle cures, aided by anecdotes about exceptional responders who have experience dramatic, but highly rare, positive responses to such treatment.

In the US, this problem is compounded by advertisements run by both pharmaceutical companies and hospitals — aimed at people with aggressive forms of cancer. The enthusiasm for the possibilities of precision oncology has created extreme levels of optimism, which cannot be matched today in terms of treatment success volumes.

What should advanced-stage cancer patients do in such a scenario?

It is important for patients and their families to understand the basic differences between ‘personalized cancer medicine’ and ‘personalized cancer treatment’. The latter works for patients at a much larger scale.

As described earlier, personalized medicine^[3] involves doctors learning about a patients’ genetic makeup and about how their tumor is growing. With this information, doctors can hope to find breakthrough treatment strategies that may (or may not) be effective.

But in order to find sustainable treatments that combine minimum side effects with maximum outcome benefits, patients should always aspire to receive personalized (read: customized) cancer treatment plans.

A personalized cancer treatment plan involves a team effort by expert oncologists with specializations in different disciplines, such as medical, surgical and radiation oncology. This team must perform the following:

• A thorough clinical evaluation of the complete medical history of that patient
• A detailed understanding of what procedures have been performed in the past and their impact on the patient’s condition
• An analysis of the patient’s projected response rate to different medications, and/or surgery
• Predicting the risk of metastasis for that patient
• Predicting the risk of recurrence or relapse for that patient
• Creating a follow-up/compliance plan after the patient completes treatment
• Psychological counseling discourses as seen necessary for that patient

Discarding blind hope and making informed decisions is of utmost importance

Precision oncology is understandably lucrative at the outset. But people need to understand that by their very nature (based on individual genome sequencing of tumors), each precision cancer drug is destined to help only a small fraction of people. Obviously, everyone with cancer wants to be in that fraction. Hope is an important part of any patient’s treatment journey. But in the wake of cancer-related deaths and cases of misdiagnosis on the rise, all involved stakeholders for breakthrough therapies must become sensitive towards how the promise of precision medicine is communicated to patients and their family members.