Cancer research has become extraordinarily good at finding new treatments, but we remain far less sophisticated at determining who should receive them. Patient selection must become as important as drug development itself. Otherwise, we risk giving powerful medicines to patients who cannot benefit while overlooking the people for whom those same medicines could be transformative.
This matters because cancer does not behave according to averages. Two patients can have the same diagnosis and respond completely differently to the same therapy. Yet much of oncology still asks the broad question: Does the drug work?
We need to ask another question with equal urgency: For whom does it work? Technology Networks reported that precision approaches are increasingly guiding treatment decisions, clinical-trial design, and drug development from the earliest stages. In the OPTIMA trial, genomic testing identified a group of patients aged 40 and over with hormone-sensitive, early-stage breast cancer who could potentially avoid chemotherapy without materially compromising outcomes.
Around 68 percent of participants had a low Prosigna score, and five-year outcomes in that group were similar with or without chemotherapy. This illustrates how more precise patient selection can reduce unnecessary treatment and its associated toxicity. But having more data does not necessarily mean understanding cancer better.
Despite these advances, some treatment decisions still rely on a limited set of biomarkers that may not capture the full complexity of a tumor. A tumor is not a single switch. Its biological chain runs from DNA to messenger RNA to proteins, and much of what DNA makes possible never becomes an actual cellular function.
DNA reveals much of a tumour's genetic potential, while RNA can provide additional information about which genes are being expressed. The more faithfully we capture that biology, the better positioned we are to understand why one patient responds while another does not. Getting that distinction wrong has consequences far beyond a disappointing trial result.
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