Interesting set of articles. How should we name & classify tumors today?
In January 2024, Andre' et al. argued in NATURE that tumor nomenclature must change, must be "unstuck" from traditional organ types. Here.
In a new June 2024 article, Ilie' et al. respond in J Clin Oncol that Andre's viewpoint raises as many issues as it solves, and a path forward should encompass both tissue and molecular features. Here. (It's not direct open access, but see next.)
One of the Ilie authors, David Horgan, describes the two papers in a detailed posting on Linked In. Here. It includes a Linked-In, downloadable, copy of the Ilie' PDF.
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See an article by Fasola 2022 that modern molecular tumor boards shouldn't just "tack on molecular" but require a rethinking from the ground up. Here. [abstract]. On systems redesign, see also Dagogo-Jack 2023 (here).
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Tumor classifications adjust greatly over time. I recall that while in neuropathology fellowship in the 1990s, I got a copy of Percival Bailey's major textbook, Classification of Tumors of the Glioma Group (here) which felt as hard to read as Chaucer, from the perspective of a student trying to decipher tumor nomenclature. That much had changed in 65 years,1926-1991.
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AI Corner.
Chat GPT4 discusses the articles. [ /Start AI text. ]
Let's begin by outlining each article's core arguments and contributions to the ongoing debate about tumor naming and classification in oncology.
ANDRE Article: "Tumor Classification Must Go Molecular"
The "ANDRE" article published in Nature argues for a radical shift from traditional organ-based cancer classifications to molecular-based classifications. Here are the key points:
- Organ-based Limitations: The authors highlight that the current system, which classifies cancers based on the organ of origin, is outdated and restricts access to effective treatments for patients with metastatic cancers.
- Advancements in Molecular Profiling: The article points out that molecular profiling has allowed for a more precise understanding of tumors, which can significantly enhance targeted therapy.
- Impact on Clinical Trials: The reliance on organ-specific classifications has led to delays in clinical trials for drugs that could be effective across multiple cancer types but are only tested sequentially for each organ-specific type.
- Educational and Clinical Implications: There is a call for educational reform to focus more on molecular mechanisms rather than memorizing organ-specific trials, which would streamline medical education and improve clinical practice.
Ilie Article: "Navigating Change in Tumor Naming: Exploring the Complexities and Considerations"
The "Ilie" article published in the Journal of Clinical Oncology provides a counterpoint to the "ANDRE" article by proposing a more cautious approach to the shift towards molecular classifications:
- Acknowledgment of Complexity: It agrees that molecular profiling enhances cancer treatment but emphasizes the complexity of completely transitioning to molecular classifications.
- Balanced Approach: The authors advocate for a dual approach that integrates both organ-based and molecular classifications, acknowledging the merits and limitations of each.
- Practical Considerations: Concerns are raised about the feasibility of universal molecular profiling, particularly regarding the availability of targeted therapies for all patients and the challenges in clinical trial design.
Horgan's LinkedIn Blog: Reflections on Molecular Classifications
The blog by Denis Horgan on LinkedIn provides additional context and support for the molecular approach:
- Advocacy for Change: Horgan supports the shift towards molecular classifications, pointing out the potential for this approach to revolutionize personalized medicine and reduce inequities in treatment access.
- Real-world Implications: The blog brings our attention to the practical implications for regulatory frameworks and healthcare systems, stressing the need for adaptive policies that can accommodate rapid advancements in cancer treatment.
Summary
In the evolving landscape of oncology, the debate over tumor classification—whether to stick with traditional organ-based methods or transition to molecular-based classifications—has never been more pertinent.
- The "ANDRE" article from Nature makes a compelling case for a shift towards molecular classifications, arguing that this approach aligns better with the advancements in precision medicine and can significantly enhance the efficacy of targeted therapies.
- On the other hand, the "ILIE" article in the Journal of Clinical Oncology urges caution, advocating for a balanced approach that integrates both molecular and organ-based classifications to address the practical and clinical challenges of a complete transition.
Denis Horgan’s reflections on LinkedIn further enrich this debate by emphasizing the potential of molecular classifications to revolutionize patient care and reduce treatment disparities. However, he also highlights the need for adaptive regulatory and healthcare infrastructures to support these changes.
Today we stand at this critical juncture, and it is clear that while the promise of molecular profiling is vast, its implementation must be approached with a nuanced understanding of its impacts on clinical practice, trial design, and educational frameworks. As cancer experts, pathologists, and biotech or genomic developers, our roles in navigating and shaping this transition will be crucial in ensuring that the benefits of molecular insights are realized across all aspects of patient care. [ /End AI text ]
