In the world of oncological medicine, a major development is underway: the transition from a classification of cancers based on the affected organ to a more precise approach focused on the molecular characteristics of tumors. This transition to precision medicine promises to significantly improve the treatments available to patients.
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Cancers are generally classified according to the organ where they appear. However, this method has become less relevant because many cancers share common molecular characteristics. Current treatments focus on the biology of the cancer rather than its location. This approach can limit the development of new drugs. Potentially effective treatments could be overlooked simply because they have not been tested on a particular organ. For example, people suffering from certain cancers expressing moleculemolecule PD-L1 have had to wait years for effective treatments like nivolumab because of these restrictions. These considerations are discussed in an article in the journal Nature.
Towards precision medicine
For twenty years, precision medicine has made it possible to identify molecular markers common to several types of cancer. This finding suggests that treatment targeting a specific marker could be effective against different cancers sharing that marker. However, in several countries, including France, treatments are not reimbursed if they have not been tested for the specific cancer of the organ concerned. In the United States, opalarib, an effective treatment for ovarian cancer with certain mutations, was not approved for other cancers sharing these mutations until several years later. This delay potentially prevented many patients from benefiting from this treatment.
Necessary changes and new challenges
The current classification of cancers poses a challenge for doctors, who must assimilate a large amount of information. Changing the classification to focus on molecular characteristics would simplify their work. Changing the current approach to focus on molecular markers rather than the organ could improve patients’ understanding of treatments and increase adherence. However, aligning health authorities and learned societies with these new criteria remains a challenge. Efforts are underway in this direction. This will require an adaptation of healthcare systems, particularly in mattermatter access to molecular tests.
