Unique Molecular Landscapes in Cancer: Implications for Individualized, Curated Drug Combinations
Cet article plaide pour une nouvelle approche des essais cliniques qui, prenant en compte l'hétérogénéité des tumeurs, évaluent des combinaisons individualisées de traitements pour chaque patient
With increasingly sophisticated technologies in molecular biology and 'omic' platforms to analyze patients' tumors, more molecular diversity and complexity in cancer are being observed. Recently, we noted unique genomic profiles in a group of patients with metastatic breast cancer based on an analysis with next generation sequencing (NGS); amongst 57 consecutive patients, no two had the same molecular portfolio (1). Applied genomics therefore appears to represent a disruptive innovation in that it unveils a heterogeneity to metastatic cancer that may be ill suited to canonical clinical trials and practice paradigms. Upon recognizing that patients have unique tumor landscapes, it is possible that there may be a 'mismatch' between our traditional clinical trials system that selects patients based on common characteristics in order to evaluate a drug (drug-centric approach), and optimal treatment based on curated, individualized drug combinations for each patient (patient-centric approach).
Cancer Research , résumé, 2014