Precision or imprecision medicine?

Nature Reviews Clinical Oncology

13,

713

(2016)

doi:10.1038/nrclinonc.2016.190

Published online: 18 November 2016

Subject terms:

The term ‘precision medicine’ is abundant in the medical literature. But, what do we understand by this term? In clinical oncology, an accepted definition of precision medicine refers to therapeutic decisions guided by the molecular or genomic features of a tumour rather than on the basis of clinicopathological features. On closer examination, however, one wonders whether what we've unleashed is imprecision medicine. The SHIVA trial, for example, was received with both enthusiasm and disdain by the clinical community. The key conclusion from this prospective randomized study was that, for patients with solid tumours who had received several lines of treatment, no progression-free survival (PFS) benefit was derived from molecularly targeted therapies compared with physician's choice of conventional therapy. Are these results bad news for those who expected precision medicine to become an instant solution to cancer management? In this issue, Le Tourneau and Kurzrock discuss this question 1 year after the publication of the trial results from SHIVA. The authors clarify one important consideration when interpreting the negative results of this study: SHIVA was an algorithm-testing trial. In other words, it was powered to determine whether the use of an algorithm-based approach to treatment allocation can improve patient outcomes — regardless of the nature of such allocated treatments.