Plutynski, Anya
Why Precision Oncology is Not Very Precise (and why this should not surprise us).
Springer, Netherlands.
Abstract
Precision oncology seems for many the best bet for precision medicine generally. In the ideal case, there is a test provided to patients, which will either provide clear-cut prognoses, or targeted therapy, given the presence or absence of specific biomarkers, followed by significant improvement in overall survival, with fewer side effects than typical for many cancer therapies. I will argue that in the vast majority of applications of precision oncology, what we actually find, and indeed ought to expect, are rather different outcomes. Cut-offs for relevant biomarkers are contested and value-laden decisions, there appear to be moderate improvements in survival in the vast majority of cases, and overall, very few cancer patients are likely to benefit (cf. Hey et. al. 2016; Tannock et. al. 2016; Marquart et. al. 2018). In this paper, I’m going to first explain why this is true, and why this should (by now) not surprise us. Cancer’s heterogeneity and complexity ought, by now, to lead us to be skeptical of “magic bullet” thinking in cancer treatment. Moreover, I argue that better communication of the scope and limits of precision oncology is essential to avoiding the unethical engagement of prospective participants in clinical trials.
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