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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."