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The European Union and personalised cancer medicine

(EJC, 2021)

By John Hickman, Ian Tannock, Lisa Hutchinson and Lydie Meheus

This paper discusses two recent policy documents by the European Union, ‘Europe’s Beating Cancer Plan’ and its accompanying ‘Conquering Cancer: Mission Possible’. These articulate broad policies aimed at reducing cancer mortality across Europe. The focus for cancer treatment in these manifestos is the expansion of personalised cancer medicine (PCM). We address the limits of PCM in pathology-driven and pathology-agnostic PCM, briefly discussing the results of umbrella and basket trials. We suggest that the complexity, plasticity and genetic heterogeneity of advanced cancers will continue to thwart the impact of PCM, limiting it to specific pathologies, or rare subsets of them, and that caution regarding the advancement of PCM is justified. Policymakers should be wary of the hype of lobbyists, who do not acknowledge the limits of PCM.

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Limits to Personalized Cancer Medicine

(NEJM, 2016)

By John Hickman and Ian Tannock

This commentary addresses some of the reasons for the limited impact of cancer drugs targeted to the genetic lesions driving malignancies. The genetic heterogeneity of advanced cancers is a particular barrier to the effective use of single targeted therapies because there are multiple genetic drivers. The paper reviews some of the data on the use of drug combinations that attempt to overcome the challenge of genetic heterogeneity, suggesting that drug combinations are limited by significant host toxicity. In particular, the paper questions the growing use of targeted drugs guided by the next generation sequencing of tumour genomes, in so-called precision or personalised medicine trials. It asks that this approach is only taken as part of well-controlled trials and that patients should be informed of the limits of personalised cancer medicine with targeted therapies.

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Blockchain’s potential to improve clinical trials

(BMJ, 2019)

By Leeza Osipenko

“Blockchain” has become a buzzword. Some entrepreneurs and researchers evangelise its promise of innovation, but others are turned off by the hype surrounding the technology. Blockchain sceptics warn about high costs. There’s more to this tamperproof technology than bitcoin. It could be used to improve the administration of clinical trials, ensuring transparency and yielding better quality data. Patients taking part in clinical trials deserve every record to be counted, appropriately handled, and independently assessed. Increased transparency and data integrity would help to accomplish this. The remit of regulators and the funders of non-commercial research is to protect and advance public health—and therefore they, rather than industry or academia, should lead blockchain’s implementation in managing clinical trials.

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