Photo Credit: Christoph Burgstedt
Next-generation sequencing, proteomics analysis, and circulating tumor DNA demonstrate how precision medicine advances thoracic oncology surgery.
A review published in the journal Cancers examines how precision medicine pushes thoracic oncology forward.
Approaches like next-generation sequencing, proteomics analysis, and molecular imaging are among the new tools that help clinicians choose therapies, plan surgeries, and care for patients after resection, Giulio Maurizi, MD, PhD, and colleagues wrote.
“Surgical strategies now adapt to these insights: a tumor that responds dramatically to targeted neoadjuvant therapy might require less extensive resection, whereas a tumor with a more aggressive molecular profile may necessitate broader intervention,” the authors wrote.
The new technology is not without its challenges, however.
“Integrating large volumes of molecular data into daily practice is non-trivial, requiring robust bioinformatics pipelines, clear interpretation standards, and continuous education for clinicians. Ethical questions—privacy, consent, equitable access, and potential genetic discrimination—are now part of the thoracic oncology conversation,” Dr. Maurizi and colleagues wrote. “Finally, the field is dynamic: as new biomarkers are discovered and new drugs approved, we must anticipate a rapidly evolving standard of care.
The reviewers set out to create “a comprehensive overview of how precision medicine principles are being integrated into thoracic surgical oncology, highlighting opportunities, barriers, and future directions.”
Clinical & Ethical Challenges
Despite these advances, Dr. Maurizi and colleagues wrote, there is work to be done before clinicians can fully capitalize on the benefits of precision medicine.
“Standardizing methodologies, proving cost-effectiveness, and refining guidelines remain critical steps before these technologies become routine,” the reviewers wrote. “NCCN and ESMO currently recommend molecular testing for key driver mutations and immunotherapy markers in NSCLC, yet they do not comprehensively incorporate multi-omic profiling strategies, reflecting the nascent state of these approaches.”
Access is also an issue. These technologies are expensive and have specific technical requirements, and the use of ctDNA carries its challenges. “While ctDNA monitoring can detect minimal residual disease earlier than imaging, questions persist regarding assay sensitivity, specificity, and standardization,” Dr. Maurizi and colleagues wrote.
Finally, they noted that there are ethical considerations, such as concerns about informed consent and privacy, as well as potential genetic discrimination. There are also ethical questions about whether and how to disclose other diseases or problems that might be found incidentally. Professional organizations will need to adopt standards to address these ethical issues.
“Integrating oncogenomic, proteomic, transcriptomic, epigenomic, and other multi-omic data streams rapidly transforming the landscape of thoracic surgical oncology, influencing every step of the diagnostic and therapeutic pathway,” the researchers wrote. “By analyzing the molecular underpinnings of each patient’s tumor—encompassing mutation profiles, pathway activations, immune signatures, and epigenetic alterations—clinicians can now tailor both systemic and surgical approaches with a level of precision previously unattainable.”
