Cancer Care Needs Better Tests, Not Just More Drugs | Opinion

Cancer research has made remarkable strides in creating new treatments, yet the ability to identify the right patients for those treatments remains inadequate. Selecting the appropriate patients is as crucial as developing the drugs itself, or else we risk administering effective medicines to unsuitable patients while overlooking those who might benefit immensely.

This issue matters because cancer does not adhere to average patterns. Two patients with the same diagnosis can react dramatically differently to the same therapy. Yet, oncology often focuses on the broad question of whether a drug works without considering who benefits from it. Advances in technology are guiding treatment choices, clinical trial designs, and drug development earlier in the process.

In a trial called OPTIMA, genomic testing identified patients over 40 with hormone-sensitive, early-stage breast cancer who might avoid chemotherapy without significantly impacting outcomes. Around 68 percent of these participants had a low Prosigna score, and their five-year results were similar with or without chemotherapy. This example demonstrates how precise patient selection can reduce unnecessary treatment and its adverse effects.

However, having more data does not guarantee a deeper understanding of cancer. Treatment decisions still rely on limited biomarkers that may not fully capture a tumor's complexity. Tumors are not singular entities but rather a series of biological processes from DNA to messenger RNA to proteins, and many of what DNA produces may not translate into actual cellular functions.

Capturing the biology accurately is essential for understanding why one patient responds while another does not. Misidentifying this distinction can have severe consequences beyond a trial's disappointing results. Patients receiving ineffective treatments may suffer from toxicity without therapeutic benefit while the cancer continues to grow.

As tumors evolve, they can develop additional resistance mechanisms. For advanced disease patients, lost time can mean missing out on potentially effective therapies. The waste also affects the entire healthcare system, consuming money, clinical capacity, hospital resources, and patients' limited time. Every ineffective treatment and trial averaging away genuine responder populations risks discarding therapies that could help specific groups.

We could invest billions in discovering new medicines while failing to fully utilize existing ones. This problem requires a shift in how we approach patient selection. Drug developers should incorporate patient-selection strategies from the beginning rather than adding them after disappointing results. Clinical researchers should design trials to identify meaningful responder populations, not just measure population-wide averages.

Hospitals should keep tumor samples, molecular information, and detailed outcome records to fuel better predictive tools in the future. Healthcare leaders should demand the same level of precision in treatment decisions as they do in scientific research. Evidence shows that the field is moving in this direction. Biomarkers are increasingly influencing treatment decisions and early-stage development, moving beyond patient stratification.

If this trend continues, precision oncology can transform from merely classifying patients to becoming the foundation of a healthcare system. Patients won't have to waste precious months discovering that a treatment was never likely to work. Their tumor will be analyzed more deeply, therapy will be selected based on its biology, and unnecessary toxicity will be avoided.

Clinical trials will become smaller and smarter, and promising drugs will be less likely to be discarded due to hidden benefits within averages. The full potential of precision oncology lies in making better decisions about who should receive treatments, not just finding more treatments. Thomas H. Jensen, CEO of Allarity Therapeutics, a company developing cancer treatments and proprietary companion diagnostics, holds these views.