Personalised medicine for cancer: from drug development into clinical practice

Personalised management of cancer means the prescription of specific therapeutics that are best suited for an individual patient and the type of tumour. Molecular diagnostics influences cancer management in several ways that aid personalisation. These technologies are enabling the classification of cancer, using molecular profiles, as a basis for more effective personalised therapies. Using microarrays, classification of a cancer based on the gene expression profile is important for personalising cancer therapy. Molecular imaging, such as by positron emission tomography, enables determination of tumour response to drug action at the molecular level. The combination of diagnostics with therapeutics - an important feature of personalised cancer therapy is facilitated by the use of monoclonal antibodies and nanobiotechnology. Development of drug resistance - an important problem in cancer management - varies according to the anticancer agent, type of tumour and individual patient. There are no universal strategies to overcome drug resistance in cancer. Various efforts to deal with this problem should be tailored to each patient, and examples are given in this review. A better understanding of cancer biology will facilitate rational drug discovery for cancer, by linking the various pathways involved to targeted therapies. Oncoproteomics will play an important role in the development of personalised cancer therapy. Use of pharmacogenomic technologies in early clinical trials is enabling rapid assessment of the efficacy of anticancer agents, and reducing the time of drug development. Application of pharmacogenetics will reduce the adverse effect of anticancer drugs. Cell/gene therapies, cancer vaccines and RNA interference will facilitate the development of personalised cancer therapy.