A recent editorial published in the ESMO Daily Reporter raises questions about the impact of precision medicine in personalized cancer care, considering that "patients are still largely treated according to the primary organ where their cancer originates." Tumour-agnostic agents, drugs approved if cancer cells cause gene or protein changes, no matter where in the body the cancer originated, calls for physicians and patients to engage in precision medicine, "a first step toward a common understanding...in which tissue-agnostic development should be preferred to conventional trials."
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Tissue-agnostic therapy was a breakthrough idea, but its limits are becoming clearer — a shared mutation does not always mean a shared response across tumour types. Tumour context, co-mutations and the local environment still shape outcomes in ways a single biomarker cannot capture. This nuance is regularly picked apart by the two onc docs, because precision oncology only works when clinicians know both what a biomarker promises and where it stops.
ReplyDeleteThe editorial's point about patients still being treated by primary organ is a reality check the field needed — tissue-agnostic approvals made headlines, but the clinic runs on histology in ways no biomarker can erase. A shared driver mutation means very different things in different tissue contexts, and co-mutations modulate it further. The call to prefer tissue-agnostic development to conventional trials only works if the trial design respects those limits rather than assuming a mutation is destiny.
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