According to the paradigm of precision medicine, the administration of agents targeting the molecular alteration detected in a particular patient’s tumour reduces uncertainty in the clinical management of that patient. We describe how approaches to precision medicine can lead, paradoxically, to increased levels of uncertainty. We offer recommendations for how physicians can better navigate new uncertainties in precision medicine.
References
Harris, M. H. et al. Multicenter feasibility study of tumor molecular profiling to inform therapeutic decisions in advanced pediatric solid tumors: the individualized cancer therapy (iCat) study. JAMA Oncol. 2, 608–615 (2016).
Hayes, D. F. et al. Breaking a vicious cycle. Sci. Transl. Med. 31, 196cm6 (2013).
Poonacha, T. K. & Go, R. S. Level of scientific evidence underlying recommendations arising from the National Comprehensive Cancer Network clinical practice guidelines. J. Clin. Oncol. 10, 186–191 (2011).
Fleck, L. M. Personalized medicine’s ragged edge. Hastings Cent. Rep. 40, 16–18 (2010).
Fehrenbacher, L. et al. in 2017 San Antonio Breast Cancer Symposium Day 2 GS1-02 (San Antonio, TX, USA, 2017).
Camidge, D. R. et al. Activity and safety of crizotinib in patients with ALK-positive non-small-cell lung cancer: updated results from a phase 1 study. Lancet Oncol. 13, 1011–1019 (2012).
Le Tourneau, C., Kamal, M. & Bièche, I. The SHIVA01 trial: what have we learned? Pharmacogenomics 18, 831–834 (2017).
Bar-Hillel, M. & Fischhoff, B. When do base rates affect predictions? J. Pers. Soc. Psychol. 41, 671–680 (1981).
Kahneman, D. Thinking, Fast and Slow (Farrar, Straus and Giroux, New York, 2011).
Acknowledgements
J.K. is funded by Genome Canada/Genome Quebec (PACEOMICS).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The authors declare no competing interests.
Rights and permissions
About this article
Cite this article
Kimmelman, J., Tannock, I. The paradox of precision medicine. Nat Rev Clin Oncol 15, 341–342 (2018). https://doi.org/10.1038/s41571-018-0016-0
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41571-018-0016-0
- Springer Nature Limited
This article is cited by
-
Risk and benefit for umbrella trials in oncology: a systematic review and meta-analysis
BMC Medicine (2022)
-
Evaluating a therapeutic window for precision medicine by integrating genomic profiles and p53 network dynamics
Communications Biology (2022)
-
A role for microfluidic systems in precision medicine
Nature Communications (2022)
-
Precision medicine and the principle of equal treatment: a conjoint analysis
BMC Medical Ethics (2021)
-
Integrin ανβ6 Protein Expression and Prognosis in Solid Tumors: A Meta-Analysis
Molecular Diagnosis & Therapy (2020)