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Review
. 2024 Mar 26:2:e4.
doi: 10.1017/pcm.2024.1. eCollection 2024.

Challenges and solutions to system-wide use of precision oncology as the standard of care paradigm

Nesrine Lajmi  1 , Sofia Alves-Vasconcelos  2 , Apostolos Tsiachristas  3 , Andrew Haworth  1 , Kerrie Woods  4 , Charles Crichton  4 , Theresa Noble  4 , Hizni Salih  4 , Kinga A Várnai  4 , Harriet Branford-White  4 , Liam Orrell  1 , Andrew Osman  5 , Kevin M Bradley  6 , Lara Bonney  2   4 , Daniel R McGowan  4 , Jim Davies  7 , Matthew S Prime  1 , Andrew Bassim Hassan  2   4
Affiliations
Review

Challenges and solutions to system-wide use of precision oncology as the standard of care paradigm

Nesrine Lajmi et al. Camb Prism Precis Med. .

Abstract

The personalised oncology paradigm remains challenging to deliver despite technological advances in genomics-based identification of actionable variants combined with the increasing focus of drug development on these specific targets. To ensure we continue to build concerted momentum to improve outcomes across all cancer types, financial, technological and operational barriers need to be addressed. For example, complete integration and certification of the 'molecular tumour board' into 'standard of care' ensures a unified clinical decision pathway that both counteracts fragmentation and is the cornerstone of evidence-based delivery inside and outside of a research setting. Generally, integrated delivery has been restricted to specific (common) cancer types either within major cancer centres or small regional networks. Here, we focus on solutions in real-world integration of genomics, pathology, surgery, oncological treatments, data from clinical source systems and analysis of whole-body imaging as digital data that can facilitate cost-effectiveness analysis, clinical trial recruitment, and outcome assessment. This urgent imperative for cancer also extends across the early diagnosis and adjuvant treatment interventions, individualised cancer vaccines, immune cell therapies, personalised synthetic lethal therapeutics and cancer screening and prevention. Oncology care systems worldwide require proactive step-changes in solutions that include inter-operative digital working that can solve patient centred challenges to ensure inclusive, quality, sustainable, fair and cost-effective adoption and efficient delivery. Here we highlight workforce, technical, clinical, regulatory and economic challenges that prevent the implementation of precision oncology at scale, and offer a systematic roadmap of integrated solutions for standard of care based on minimal essential digital tools. These include unified decision support tools, quality control, data flows within an ethical and legal data framework, training and certification, monitoring and feedback. Bridging the technical, operational, regulatory and economic gaps demands the joint actions from public and industry stakeholders across national and global boundaries.

Keywords: cost-effectiveness; health data; interoperability; patient centred; patient record; precision medicine; precision oncology; standard of care.

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Conflict of interest statement

A.H., A.O., L.O., M.S.P. and N.L. are employed by Roche. S.A.V., A.T., K.W., C.C., T.N., H.S., K.A.V., H.B.-W., K.M.B., L.B., D.R.M. and J.D. have no conflict of interest to disclose related to this publication. A.B.H. has no conflicts of interest with the exception of holding a research grant award at the University of Oxford from Hofmann-La Roche, Cancer Research UK, Grenfell-Shaw charity, NIHR UK, Kennel Club Charitable Trust and EPA trust.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Precision Oncology at Scale.Integrated perspective addressing challenges and solutions to precision oncology at scale. See Figure legend.
See this image and copyright information in PMC

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