Treatment Algorithms Based on Tumor Molecular Profiling: The Essence of Precision Medicine Trials

J Natl Cancer Inst. 2015 Nov 23;108(4):djv362. doi: 10.1093/jnci/djv362. Print 2016 Apr.

Abstract

With the advent of high-throughput molecular technologies, several precision medicine (PM) studies are currently ongoing that include molecular screening programs and PM clinical trials. Molecular profiling programs establish the molecular profile of patients' tumors with the aim to guide therapy based on identified molecular alterations. The aim of prospective PM clinical trials is to assess the clinical utility of tumor molecular profiling and to determine whether treatment selection based on molecular alterations produces superior outcomes compared with unselected treatment. These trials use treatment algorithms to assign patients to specific targeted therapies based on tumor molecular alterations. These algorithms should be governed by fixed rules to ensure standardization and reproducibility. Here, we summarize key molecular, biological, and technical criteria that, in our view, should be addressed when establishing treatment algorithms based on tumor molecular profiling for PM trials.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Biomarkers, Tumor / genetics
  • Clinical Trials as Topic
  • DNA Copy Number Variations
  • Drug Resistance, Neoplasm / drug effects
  • Drug Resistance, Neoplasm / genetics
  • Gene Dosage
  • Gene Expression Profiling*
  • Gene Expression Regulation, Neoplastic
  • Gene Silencing / drug effects
  • Genes, Tumor Suppressor / drug effects
  • High-Throughput Nucleotide Sequencing
  • High-Throughput Screening Assays
  • Humans
  • Molecular Targeted Therapy / methods
  • Molecular Targeted Therapy / trends*
  • Neoplasms / genetics*
  • Neoplasms / therapy*
  • Precision Medicine / methods*
  • Precision Medicine / trends
  • Signal Transduction / drug effects*

Substances

  • Biomarkers, Tumor