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February 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

Why Tumor Naming Has to Change

There is a growing disconnect between classifying cancers according to the organ in which the tumor originated and developments in precision oncology, which uses the molecular profiling of tumor and immune cells to guide therapies. Classifying cancer according to the organ in which it originated is making it harder for patients to obtain the drugs that could help them. In fact, when it comes to regulators approving the use of treatments, molecular-based classifications are likely to become ever more important as more drugs are developed using advanced biotechnologies.

The past two decades of cancer research, which have been dominated by efforts to characterize tumors at the cellular and molecular level, have shown that some of the molecular events driving their evolution are shared across different ‘types’ of cancer. Mutations in the tumor suppressor gene TP53, for example, are a feature of most types of cancer, as defined by the organ in which the cancer originated. What’s more, most cancer types can be subdivided into different molecular subgroups. Some lung cancers have mutations in the epidermal growth factor receptor (EGFR) gene, some have mutations in the MET gene, others have translocations involving the ALK gene, and so on. Antibody drug conjugates, for instance, are antibodies that target membrane proteins expressed by multiple types of cancer to deliver chemotherapy to tumor cells. The antibody drug conjugate trastuzumab deruxtecan has already shown promise in phase I and phase II trials in treating people whose cancers either overexpress the HER2 gene or have a mutated version of it, regardless of the organ in which their cancer originated.

Molecular-based classifications could also improve people’s adherence to treatment. The fact that any two patients diagnosed with the same cancer type can be given different treatments causes confusion and misunderstanding. And if patients are also told about the biological mechanisms driving their cancer, they will understand the rationale for treatment better.

According to Fabrice André and his co-authors from the Research Division at Gustave Roussy, Department of Oncological Medicine, Villejuif, France, classifying cancers according to their molecular characteristics would expedite the access of millions of people to effective treatments; it is also the first step towards precision oncology and a deeper biological understanding of how cancer works. “This will require radical changes in how medical oncology is structured, conducted and taught.”

Nature. 2024; 626: 26-29
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.