Preventive, predictive, and personalized medicine for effective and affordable cancer care
- 14 Downloads
Preventive, predictive, and personalized medicine (PPPM) has created a wealth of new opportunities but added also new complexities and challenges. The European Cancer Prevention Organization already embraced unanimously molecular biology for primary and secondary prevention. The rapidly exploding genomic language and complexity of methods face oncologists with exponentially growing knowledge they need to assess and apply. Tissue specimen quality becomes one major concern. Some new innovative medicines cost beyond any reasonable threshold of financial support from patients, health care providers, and governments and risk sustainability for the health care system. In this review, we evaluate the path for genomic guidance to become the standard for diagnostics in cancer care and formulate potential solutions to simplify its implementation. Basically, introduction of molecular biology to guide therapeutic decisions can be facilitated through supporting the oncologist, the pathologist, the molecular laboratory, and the interventionist. Oncologists need to know the exact indication, utility, and limitations of each genomic service. Minimal requirements on the label must be addressed by the service provider. The interventionist is there to bring the most optimal tissue sample to pathology where the tissue is expanded to a variety of appropriate liquid-based samples. The large body of results then should be translated into meaningful clinical guidance for the individual patient. Surveillance, with the appropriate application of health economic indicators, can make this system long lasting. For governments and health care providers, optimal cancer care must result in a cost-effective, resource-sustainable, and patient-focused outcome.
KeywordsPredictive preventive personalized medicine Molecular biology Patient selection Cancer care Biopsy Genomic profiling Health economics
The authors thank Mrs. Sabine Janssens for preparing the manuscript. The authors were not paid to write this article. They have connections with the industry (Conflict of Interest). This paper represents the consolidated opinion of the European Cancer Prevention Organization regarding preventive, predictive, and personalized medicine.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of informed consent
Patients have not been involved in the study.
Statement of human and animal rights
No experiments have been performed including patients and/or animals.
- 1.Davis C, Naci H, Gurpinar E, Poplasvka E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13. BMJ. 2017;359:j4530.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Janssens J, Gallagher WM, Dean A, Ussla G, Stamp G. Tumor profiling-directed precision cancer therapy—comparison of commerical and academic clinical utility. Int J Surg Surgical Proced. 2017;2:123.Google Scholar
- 12.Agorku D, Janssens J. Isolation and analysis of tumor cells from human solid tumor tissue extracted by needle biopsy. Application Note Miltenyi Biotec. 2017;Google Scholar
- 14.Simon R, Roychowdhury S. Implementing personalized cancer genomics in clinical trials. Nature Rev Drug Discov. 2013;12:358–69.Google Scholar
- 19.Temple, R. Clinical measurement in drug evaluation. Ningano W. Thicker GT, eds. John Wiley and Sons Ltd: 1995; Von Hoff, D.D. c 1999; Dhani et al. Clin Cancer Res 2009; 15: 118–123.Google Scholar
- 20.Radovich M, Kiel PJ, Nance SM, Niland EE, Parsley ME, Ferguson ME, et al. Clinical benefit of a precision medicine based approach for guiding treatment of refractory cancers. Oncotarget. 2017;7:56491–500.Google Scholar
- 22.Cree IA, Deans Z, Ligtenberg MJL, Normanno N, Edsjö A, Rouleau E, Solé F, Thunnissen E, Timens W, Schuuring E, Dequeker E, Murray S, Dietel M, Groenen P, Van Krieken JH, European Society of Pathology Task Force on Quality Assurance in Molecular Pathology, Royal College of Pathologists. Guidance for laboratories performing molecular pathology for cancer patients. J Clin Pathol. 2014;67(11):923–31. https://doi.org/10.1136/jclinpath-2014-202404.
- 23.Guidance for laboratories performing molecular pathology for cancer patients. J Clin Pathol. 2014; 67: 923–931.Google Scholar
- 24.Capdevila J, Rojo F, Gonzalez-Martin A, et al. Molecular profiling for clinical decision making in advanced cancer: a clinical appraisal. J Cancer Res Treat. 2017;5:77–85.Google Scholar
- 28.Cairns J. Using cost-effectiveness evidence to inform decisions as to which health services to provide. Health Syst Reform. 2016;2:32–8.Google Scholar