Perspective: The precision-oncology illusion

Representing a “revolution”: how the popular press has portrayed personalized medicine

“…Specifically, several articles present PM as a way to assist individuals in adopting beneficial lifestyle changes, including screening behavior, diet, and exercise. Given that existing research suggests that the provision of genetic-risk information has little impact on behavior change, 16,17 these media representations seem out of step with the existing research. Indeed, the inaccurate representations of the empowerment message stand as a good example of how the media portrayals of PM may mislead both the public and policy makers about the value of some PM technologies.…”

“…For example, commentators have questioned the clinical value of the PM approach in many contexts. 1,15,16 In addition, evidence suggests that individuals are unlikely to change their behavior in response to genetic risk information, 17,18 a common justification for the adoption of PM strategies. 19 There is also concern that the introduction of PM might lead to increases in overdiagnosis, unnecessary testing, iatrogenic injuries, 20 and health-care costs.…”

New strategies in esophageal carcinoma: promises and problems

“…However, over time two limitations become obvious when targeted therapy is applied to a patient population: only a small percentage of genetic alterations can be paired with targeted drugs, and even when patients are given targeted drugs based on biomarkers only ~30% patients responded. Extension of progression-free survival (PFS) and overall survival (OS) is limited (8). As pointed out by Wang et al, anti-HER2 antibody trastuzumab in combination with conventional chemotherapy increased medium OS of HER2-positive gastroesophageal adenocarcinoma from 11.1 to 13.8 months as compared with those on standard chemotherapy (HR: 0.74; P=0.0048).…”

“…The only randomized clinical trial in the literature, the SHIVA study, showed that patients treated according to identified mutation or mutations had equally poor prognosis as those treated with conventional therapy (14). Therefore, precision oncology has been seriously questioned as an "illusion" or "hype" (8,15). Even worse, some of the foundations of targeted therapy or precious oncology have been questioned to a certain extent.…”

The GENIE Is Out of the Bottle: Landmark Cancer Genomics Dataset Released

“…Several recent reports (9,10) have questioned the clinical value of precision medicine approaches, and this remains a difficult but important question that must be addressed. With 19,000 samples, increasing to 100,000 within 5 years, Project GENIE will offer unparalleled insights into the applicability of cancer genomic profiling at a routine population level.…”