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Maybe Someday, But Maybe Not

In an essay at Nature, Oregon Health and Science University's Vinay Prasad argues that precision medicine for cancer is largely an 'illusion' despite high hopes for such treatment. Few patients, he says, have benefitted so far from a precision medicine approach.

According to Prasad, two sequencing efforts aimed at matching cancer patients to therapies based on their tumors' genetic profiles have only been able to pair a portion of patients — 6.4 percent for MD Anderson Cancer Center and 2 percent for NCI-MATCH — with treatments.

Part of the issue there, notes Derek Lowe at In the Pipeline, is that there just aren't that many tailored drugs. Further, Prasad adds that only a portion of patients have had an exceptional response to such treatment.

"In the big oncology picture, there aren't many of those at all, so for most patients (arguably 'nearly all patients') there really isn't a targeted therapy to offer," Lowe writes.

Another issue Prasad raises is that there has been only one randomized controlled trial of precision medicine in oncology, the SHIVA trial. And it, he says, found reported a median progression-free survival of 2.3 months and 2.0 months, respectively, for patients whose treatment was guided by their genetic profile and for patients given the treatment recommended by their doctors. Additional studies, he says, are needed.

"Precision oncology is inspirational. What doctor or patient would not want to harness genetics to tailor a therapy to an individual?" Prasad writes. "But traveling back in a time machine is also inspirational."

The Scan

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Small Study of Gene Editing to Treat Sickle Cell Disease

In a Novartis-sponsored study in the New England Journal of Medicine, researchers found that a CRISPR-Cas9-based treatment targeting promoters of genes encoding fetal hemoglobin could reduce disease symptoms.

Gut Microbiome Changes Appear in Infants Before They Develop Eczema, Study Finds

Researchers report in mSystems that infants experienced an enrichment in Clostridium sensu stricto 1 and Finegoldia and a depletion of Bacteroides before developing eczema.

Acute Myeloid Leukemia Treatment Specificity Enhanced With Stem Cell Editing

A study in Nature suggests epitope editing in donor stem cells prior to bone marrow transplants can stave off toxicity when targeting acute myeloid leukemia with immunotherapy.