The illusion of precision oncology and other scientific paradigms

Posted: March 2, 2017, 11:54am

I love writing about science in general. I love writing about the philosophy of science in particular.

Previously, I’ve written about the trend toward precision medicine, especially in oncology. I’m a big proponent of the idea that a ‘one-size-fits-all’ might not be the best approach is cancer treatment. The idea of precision oncology begins with genetic testing to see which drug or combination of drugs will best suit a particular patient. It’s a big idea and one that is complicated by the fact of cost and the extreme variance across genetic subtypes of cancer: not all of which do we have drugs to target (…not even close).

So imagine my surprise when I hear about a new editorial in Nature that attempts to drop the hammer of reality onto the field of precision oncology. Vinay Prasad calls the scientific community to wake up and realize that we aren’t quite there yet.

“Few patients benefit from precision oncology. Data from some 2,600 people enrolled in a sequencing programme at the MD Anderson Cancer Center in Houston, Texas, showed that just 6.4% were paired with a targeted drug for identified mutations.”

He’s right. He goes on to say that just being assigned a targeted therapy isn’t proof enough for patient benefit, either.

I’d be remiss if I didn’t make a plug for modeling here. Precision medicine involves many factors. It may be the precision medicine will be aided by the invention and administration of new targeted drugs that don’t exist yet. Those low percentages of patients that benefit are due in part that there are many patients who just don’t have genetic markings of a tumor that can be matched to any particular drug in existence.. yet. But undoubtedly precision medicine will also involve supplementary information about how (and when) treatments are administered, something the modeling community can help. Can we use existing drugs in a more helpful way, just by changing the way we schedule treatments? Yes. Precision medicine will also involve preventative care: can we change the habits of people before they receive that fateful diagnosis? Also yes. We can mitigate the risk of cancers and other diseases. We can also identify at-risk populations and keep a closer eye on these.

Precision medicine: it may not be ready for prime time, but let’s wait and see.

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