ESMO calls for caution over current expectations of personalised medicine

3 February 2013

In support of World Cancer Day, The European Society for Medical Oncology (ESMO) has issued a statement to dispel the myth that personalised medicine is already a reality for all cancer types and all cancer patients.

Personalised medicine in cancer refers to the possibility to deliver the right treatment based on the characteristics, such as genetics, of the individual’s tumour, using targeted therapies directed at efficiently killing tumour cells.

“Personalised medicine is the dream of every oncologist and the legitimate expectation of every cancer patient,” says Prof Martine Piccart, ESMO President. “However, currently we are not yet in the era of personalised oncology but in the era of stratified oncology, which means we are able to identify and evaluate critical targets in the tumour to try and develop smart drugs against them. Strong technologies such as deep DNA sequencing will be powerful tools in future research, identifying drugable mutations and developing drugs specific to them.”

Underscoring these developments is the need to educate oncologists by untangling the literature and clarifying new research advances. ”Providing targeted education and fostering research is the surest route to fully realising the goal of personalised medicine in a near future,” says Prof Piccart. “ESMO is fully committed to take all necessary steps to favour this progress.”

One essential issue is the vast amount of information that has been and continues to be generated. “Oncology practitioners need help to be able to put this information into the perspective of their patients and to translate science into what will actually provide clinical benefit for them,” Prof Piccart cautions.

To this end, personalised medicine has become a linchpin of ESMO’s educational strategies. Prof Fortunato Ciardiello, ESMO Personalised Medicine Task Force Chair, emphasises that the personalisation of cancer care is now a common theme throughout all ESMO activities, offering a rich source of references through which oncologists can obtain as much valuable information as possible[1].

An example of this is the upcoming ESMO Symposium on ‘Signalling pathways in cancer: Targeting the HER/EGFR family with focus on breast, lung and colorectal cancers’[2], a personalised medicine event dealing with the evaluation of tumours at the molecular and cellular pathway levels. Its goal is to shed light on the complexity of molecular pathways and give practical guidance to clinicians on applying this knowledge towards personalised treatment for their patients.

Dr Piccart recalls that the ancestor of personalised medicine as we understand it now was first applied in the field of breast cancer, following the recognition of hormone-dependent cancers and the consequent development of agents that targeted their receptors.

A highly effective monoclonal antibody against the HER2 receptor in breast cancer was introduced back in the Nineties and almost revolutionized the way breast cancer is treated. However, it works only in women whose tumours express the HER2 gene, approximately 25% of breast cancer patients. Furthermore, resistance to this drug has already appeared, making research and development of new therapies crucial even for this targetable cancer.
“There is a huge need to improve molecular screening in breast cancer, as one way to identify driver mutations that may serve as targets for novel treatment strategies of the cluster of breast cancer diseases.”

In the meantime research in other areas has moved at a rapid pace, most evidently in lung and colorectal cancer.

“Oncologists have a double duty: to raise awareness of the current achievements of targeted therapies, of their high potential and the necessary requirements, and to guide their patients in seeking out clinical trials where their tumours can be better profiled, so that they can gain access to novel treatments.”

Patients themselves can play an important role in the acceleration of the process towards truly personalised medicine. ESMO has plans to help patients understand how they can contribute to achieve the goal.
"Make sure what you are offered is not sub-optimal! For example, where treatment heavily relies on the evaluation of critical receptors in the tumour, these delicate tests must be done in laboratories with high-quality control criteria,” stresses Dr Piccart.

"We must provide good education to oncologists and to patients, and we have an obligation to support research,” notes Dr Piccart to summarise the role of ESMO, natural reference for medical oncologists in the progress towards personalisation of cancer treatment. “We are progressively moving towards personalised oncology, and this will be a huge achievement for oncologists and cancer patients alike; we will be able to select the right treatment, avoiding both under and over treatment. But there is clearly a long way to go towards achieving this goal. We need to collaborate very intensively with partners in and outside of Europe and make sure we don’t sit back in the myth that personalised cancer medicine is already here."

[1] Annals of Oncology, the scientific journal of ESMO, supports World Cancer Day by offering open access to a selected series of publications directed towards updating and clarifying the rapidly expanding body of knowledge regarding the molecular biology of cancer.

These articles will aid oncologists by covering the current status of personalised medicine, including the translation of molecular analysis to decision-making for patient treatment:

[2] Sitges, Spain, 1-2 March 2013. For more information:




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