Personalised cancer care is becoming an increasingly important aspect of oncological practice. With the advent of high-throughput molecular profiling technology, it is now possible to identify the unique characteristics of a specific tumour and use this information to tailor treatment to the individual patient. Identification of relevant biomarkers, which include genes, proteins and other molecules, can help to ensure that specific treatments are targeted to those patients who are most likely to gain optimal benefit while avoiding the side effects of ineffective therapy. On a societal level, a personalised approach offers the potential to substantially reduce health care costs, by reducing treatment use in patients unlikely to benefit. This is especially important given the rapidly escalating economic burden of cancer that is, in part, driven by the expense of innovative new treatments.1
Most cancer therapies gain approval despite typical response rates of around only one-third of patients.2 Thus, a significant proportion of cancer patients receive treatment of limited clinical benefit. Better targeted clinical decision-making early in the disease course would improve outcomes for patients. More comprehensive and earlier use of molecular profiling could result in more patients receiving effective therapy at a stage where benefits may be optimal rather than after one or more lines of failed treatment, an especially important consideration in aggressive cancers for which the time window for effective intervention may be limited. It may also mean that patients with rare cancers, which have a limited evidence-base and fewtreatment options, may be able to benefit from existing targeted therapies. A more personalised approach to patient care, with targeted treatment directed by the molecular profile of the tumour rather than a ‘one-size-fits-all’ strategy, would also lead to more effective allocation of limited financial resources.
Over the past decade, an increasing number of targeted therapies to treat different types of cancer have been introduced and have contributed to improvements in survival rates. Among the first successful targeted agents in cancer were trastuzumab (Herceptin®) for breast cancer overexpressing the Human epidermal growth factor receptor 2 (HER2) receptor and imatinib mesylate (Gleevec®) for abnormal protein tyrosine kinase activity in chronic myeloid leukemia and gastrointestinal stromal tumours. Other examples of targeted therapies include erlotinib (Tarceva®) and gefitinib (Iressa®), both of which target epidermal growth factor receptor (EGFR)-expressing non-small-cell lung cancer (NSCLC), cetuximab (Erbitux®) for patients with EGFR-expressing metastatic colorectal cancer, crizotinib (Xalkori®) for patients with locally advanced or metastatic NSCLC that is anaplastic lymphoma kinase (ALK)-positive, and vemurafenib (Zelboraf®) for BRAF V600E mutation-positive metastatic melanoma. These treatments, and many other targeted therapies, are changing the therapeutic landscape in oncology.
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