We have seen remarkable progress in the management of cancer. More than half of cancer patients can now expect to achieve long-term survival and cure in the UK, and slightly more in countries with the very best cancer outcomes. This progress, however, has been achieved at the cost of toxicity for cancer patients and financial cost to their healthcare economies. Oncology has historically been an imprecise medical discipline that has relied heavily on empirical evidence. We generally have not been able to predict with accuracy which patients will benefit and which have the best chance of cure. Treatments are associated with toxicity as well as efficacy because we cannot precisely target the cancer. Our choice of treatment has been determined by historical probabilities and clinical characteristics because we generally lacked the means to test a cancer to determine which treatments will work and which will not. This background makes the advent of precision medicine as precision oncology especially exciting for cancer patients and cancer professionals. The dramatic advances that we have seen in our knowledge of the fundamental biology of cancer, genomics, the transcriptome and other aspects of the phenotype are now genuinely informing the tests that tell us how a cancer is likely to behave, and the treatments that we can use to influence that behaviour.
Discussions of precision oncology are often couched in highly scientific terms, bringing molecular biology, molecular genetics, proteomics and sophisticated imaging to bear on the diagnosis, prognosis and selection of treatment for a cancer. The challenges to delivering precision oncology, however, lie not only at the cutting edge of modern science but also in the way we provide cancer care and how we organize ourselves to do so. We need to communicate effectively with patients in order to personalize their care and provide them with clear choices. Organization and logistics are important themes in precision oncology. We have a growing portfolio of molecular tests to determine the behaviour of a cancer and to predict its response to therapy. We need to look carefully, however, at how they can be deployed in a hard-pressed healthcare system to bring benefits to the maximum number of patients, in the quickest time, and in the most cost-effective way. We need to be careful that the intuitive appeal of molecular testing to guide therapy does not lead us to exaggerate the potential benefits, and keep a clear-eyed view of the evidence.
This most recent book in the Association of Cancer Physicians' prize-winning Problem Solving series seeks to bring out in an accessible way the potential of precision oncology and its challenges and pitfalls. Fifteen chapters are written by leading authorities in the field to give an overview of the development of precision oncology at a molecular, clinical and patient-centred level. The 21 individual case histories are then used to illustrate how precision oncology can and should be woven into the practice of cancer medicine and the organization of healthcare services. The approach is broad and inclusive and covers all currently topical aspects of precision oncology. This is a fast-moving field and the principles that are described will be enduring, although the individual tests and the individual treatments are likely to evolve rapidly in the coming decade.
Precision oncology offers to patients the prospect of more effective treatments and the avoidance of unnecessary toxicity from treatments that do not work. Patients and patient advocates see this as a vitally important goal for oncology. The potential for improving the well-being and outcomes of treatment for cancer patients through precision oncology, and the challenge of delivering it effectively and quickly, are immense.
Ellen R. Copson, Peter Hall, Ruth E. Board, Gordon Cook and Peter Selby, Editors
Johnathan Joffe, Chairman, Association of Cancer Physicians
Peter W.M. Johnson, Chief Clinician, Cancer Research UK