Towards precision medicine in neurology, lessons learned from oncology
A very short history of precision medicine in oncology
Cancer is a complex disease with many different clinical pathologies, risk factors, disease stages, and outcomes. In their comprehensive review of cancer chemotherapy, DaVita and Chu chart the history of cancer care from the post-WWII period to the mid-2000s, showing it was characterized by (1):
limited understanding of the underlying disease mechanisms,
late diagnosis, leading to few options for treatment,
few tools for clinicians to individualize treatment, resulting in trial and error approaches,
poor standardization of diagnosis and prognosis,
debilitating side effects of cellular toxins drugs,
low remission and survival rates.
So what changed the course for cancer patients in the last decades?
Firstly, the establishment of the Cancer Chemotherapy National Service Center (CCNSC) and other bodies such as the National Institutes of Health, National Cancer Institute, American Association of Cancer Research, etc., brought together scientific and political forces to drive change and allocate significant funding (2). Secondly, building on early research on the molecular mechanisms of cancer, and accelerated by insights from the Human Genome Project, a deeper understanding of the genetic basis of cancer became available in the early 2000s (3,4). Thirdly, technology evolved and genomic data became available at scale thanks to high throughput next generation sequencing (5). Fourthly, as there was a strong belief in the power of genomic big data for cancer, large-scale adoption in clinical practice was possible, and new recommended diagnosis and treatment guidelines were developed (6).