Thursday, May 3, 2018

Brief Blog: New Cycle of Activity on "Cancer Sequencing Hype and Reality"

Science blogger Derek Lowe has a new article May 2 titled, "Cancer Sequencing Hype and Reality."  The essay is predicated on a recent debate at AACR between David Hyman of MSKCC and Vinay Prasad of OHSU.   It tracks a report on the conference published in Science by journalist Jocelyn Kaiser, here.

As Lowe tells it, in the debate, Prasad focused on the fact that only about 15% of lung cancer patients have an FDA-actionable mutation and only about half of them have a corresponding therapy response, therefore, precision medicine has too much "hype."   I'm not sure; I don't think it's a surprise to anyone in the field - it's common knowledge that a (fairly small) subset of lung cancer patients have EGFR and ALK and then ever rarer mutations.   Maybe it's "hype" that there is "hype"...

See Hyman's presentation in AACR video online, here.  Hyman's team showed that larotrectinib, an investigational drug, was active against TRK fusions in a wide range of tumors (NEJM, 2018, here.)

See an article in Medscape here that reviews Prasad's April 2018  JAMA paper on "percent of US cancer patients that benefit from genome driven oncology."

I haven't updated it but around 2015-2016 I had a blog inventory of fifteen or twenty articles, at that time, skeptical of precision medicine (here).


PubMed currently has 1300 citations for "HYPE" (here) only a few of which are the gene carbamoyl dehydratase (HYPE). 


In Nature Reviews Clinical Oncology, Kimmelman & Tannock (2018) argue that precision medicine subpopulations can be so small that any outcome and comparison studies are necessarily very limited, with large error bars, thus generating paradoxical "imprecision within precision;" here.