Precision Oncology

What Is Precision Oncology?

Precision oncology is an approach to cancer care that considers the molecular features of a tumour when selecting treatment. Two people with the same cancer type may have different genetic changes or biomarkers, which can influence how their cancers behave and which medicines may be effective.

Depending on the diagnosis, precision oncology may involve molecular profiling, genetic testing of the tumour, protein biomarker testing or other investigations. The results are interpreted alongside pathology, imaging, cancer stage, previous treatment and the patient's overall health.

Precision oncology is not a single medicine or a guaranteed cure. It is a way of using relevant clinical and molecular information to help make informed treatment decisions. Dr. Rajit Rattan's medical oncology practice in Gurugram can assess which investigations and treatment approaches may be appropriate for an individual patient.

Molecular Testing and Personalised Cancer Treatment

The tests considered depend on the cancer diagnosis and whether the results could change treatment decisions. Not every patient requires comprehensive genomic profiling, and a larger testing panel is not automatically more useful.

• Cancer genomic profiling, including next-generation sequencing (NGS), when clinically appropriate.
• Biomarker testing such as EGFR, HER2, PD-L1, BRCA or other markers selected according to the cancer type.
• Assessment of targeted therapy options when a relevant molecular alteration is identified.
• Evaluation of immunotherapy options when the diagnosis and available biomarkers support their use.
• Consideration of chemotherapy, immunotherapy, targeted medicines or appropriate combinations based on clinical evidence and individual circumstances.

Related: Targeted therapy, Immunotherapy, Chemotherapy

Which Cancers May Benefit From Precision Oncology?

Molecular and biomarker testing can guide treatment decisions in selected lung, breast, colorectal, ovarian and prostate cancers, as well as certain head and neck cancers, blood cancers and other tumour types. The value of testing depends on the specific diagnosis and whether a result could influence treatment.

In oral cancer, the role of molecular profiling and specific biomarkers depends on the tumour type, stage and clinical situation. Testing should be selected when it may provide useful information for diagnosis, prognosis or treatment planning rather than ordered routinely for every patient.

Testing may use tumour tissue or, in selected situations, a blood sample. The appropriate method depends on the cancer, the available sample and the clinical question being investigated.

Related: Lung cancer, Breast cancer, Colorectal cancer, Oral cancer

Benefits and Limitations of Precision Oncology

When a clinically relevant biomarker is identified, the result may help the oncology team select a treatment with evidence of benefit for that cancer. Testing can also show that a particular targeted medicine is unlikely to be useful, helping inform alternative treatment choices.

Not every tumour has an actionable finding, and some results have uncertain clinical significance. Even when a treatment target is found, the medicine may not work or the cancer may eventually become resistant. Precision oncology does not replace surgery, radiation therapy, chemotherapy or other established treatments when those are appropriate.

The cost of molecular testing varies according to the type of test, laboratory and clinical requirements. The cost and potential usefulness of testing, along with the availability and cost of any treatment it identifies, should be discussed before proceeding.