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Published online 11 March 2009 | Nature 458, 131-132 (2009) | doi:10.1038/458131a
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Personalized cancer therapy gets closer
Genetic testing allows doctors to select best treatment.
The long-awaited era of personalized genetic medicine may finally be arriving for people with cancer. Some cancer centres are preparing to screen all patients for genetic glitches associated with the disease, and scientists are starting to use detailed information about patients' tumour genomes to decide which treatments might benefit them most.
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This is definitely the right way to go, as cancer is an individual disease, hence so many treatment failures. But this approach has to be used carefully, as we have all seen patients respond well to drugs which their genetic tumor profile suggested should not work. As a means to suggest chemotherapeutic agents that have the highest probability of success it should be very helpful but it needs to be used inclusively and not simply to exclude treatment options. Furthermore, unfortunately,there are pharmaceutical companies very wary of this if not in opposition because it could potentially reduce the number of patients treated for less prevalent cancers and therefore result in much lower income for drugs that are near orphan status.
I think the main problem in the future will not be to sequence the tumor genome. According to the development in the sequencing technologies, the cost of the sequencing of the entire human genome will drop below 1.000 $ in the close future, and it will take a matter of a few days. The main problem is to understand the meaning of these >3 billion letters. We know the role in the tumor only of a few genes, not to speak about the role of the ?junk? regions, miRNAs or epigenetics etc. And naturally, all these interact with each other and with the environment. Unfortunately, because of this complexity, the progress will be very slow, and it will require an immense amount of bioinformatic work, as well. So, I am not so optimistic in this respect.