The present and future of precision oncology and tumor-agnostic therapeutic approaches

Abstract

Precision oncology has transformed the treatment landscape for patients with advanced solid tumors. Tumor-agnostic therapies, those that have been approved based on genetic mutations or biomarkers across tumor histology types, are important examples of how the implementation of precision oncology can expand therapeutic options for patients, especially those with rare cancer types and treatment-refractory disease. In this review, we first discuss how advances in next-generation sequencing and molecular profiling have enabled the identification of shared actionable alterations. Subsequently, we explore the current landscape of tumor-agnostic therapies that have received approval from the Food and Drug Administration. We discuss the strengths and limitations of these therapies and evaluate the clinical trial data leading to their approval. In addition, we detail updated results from these clinical trials and additional observational studies reported after the approval. Several factors such as tumor histology, specific alteration types, and the presence of co-alterations are associated with the efficacy of these therapies. Also, challenges remain in understanding resistance mechanisms and predicting response. Looking ahead, we discuss how improved diagnostic tools, novel experimental strategies, and innovative trial designs may further advance the field of precision oncology and improve therapeutic options for patients.

Keywords: biomarker-driven treatment; molecular profiling; precision oncology; targeted therapy; tumor-agnostic therapy.

Figure 1.

Tumor-agnostic approvals by FDA. Timeline of FDA accelerated (Top) and full tumor-agnostic approval (Bottom) for solid tumors. Background color reflects indication.