'Precision' Prevails Over 'Personalized' Medicine in New ESMO Glossary

November 13, 2017
'Precision' Prevails Over 'Personalized' Medicine in New ESMO Glossary
The European Society for Medical Oncology (ESMO) has published a glossary designed to standardize the language of precision medicine. [Source: © Gina Sanders/Fotolia]

The European Society for Medical Oncology (ESMO) today said it has published a glossary designed to standardize the language in the field of precision medicine, and thus improve communication between oncologists, researchers and patients.

The European Society for Medical Oncology (ESMO) Precision Medicine Glossary was published today in the journal Annals of Oncology. The Glossary includes 43 definitions that encompass what the Society says are all the concepts in precision medicine that have emerged over the past 5-10 years—all designed to provide a common terminology for oncologists.

The 43 terms are grouped into five main themes:

  • Mechanisms of decision—precision medicine (preferred), personalized medicine, pharmacogenomics, stratified medicine, molecular tumor board.
  • Characteristics of molecular alterations—mutation/genomic mutation, cancer gene, driver mutation, passenger mutation, oncogene addiction, pathogenic variant, deleterious variant, targetable genomic alteration/druggable genomic alteration, actionable genomic alteration, point mutation, insertion/deletion mutations, structural variant (preferred)/genomic rearrangement, copy number variation (germline), copy number alteration (somatic), gene amplification, copy number gain, homozygous deletion.
  • Tumor characteristics—Intra-tumor heterogeneity, inter-tumor heterogeneity, clonal evolution, cancer clone, cancer subclone, circulating tumor cells, cell free circulating tumor DNA, extracellular vesicles.
  • Clinical trials and statistics—Basket trial, umbrella trial, adaptive trial, N-of-one trial, spider plot, circos plot, waterfall plot.
  • Research tools—Liquid biopsy, patient-derived xenograft models, orthotopic animal models, humanized animal mode, tumouroids (tumour organoids), primary cultures, organotypic cultures, syngenic animal models.

“The glossary will be a dynamic entity, undergoing expansion and refinement over the coming years,” predicted the Glossary’s authors, a team whose corresponding author is Prof. Fabrice Andre, M.D, Ph.D., of Institut Gustave Roussy in Villejuif, France.

The team identified terms for inclusion in the Glossary through an ESMO member survey conducted in the autumn of 2016, as well as through ESMO Translational Research and Personalised Medicine Working Group members. Each term was defined by experts in the field, discussed and, if deemed necessary, modified by the Working Group before reaching consensus approval.

A literature search was carried out to determine which of the terms, ‘precision medicine’ and ‘personalized medicine’, is most appropriate to describe the field.

“The glossary classes ‘precision medicine’ or ‘personalised medicine’ as technically interchangeable but the term ‘precision medicine’ is favoured as it more accurately reflects the highly precise nature of new technologies that permit base pair resolution dissection of cancer genomes and is less likely to be misinterpreted,” Dr. Andre and colleagues concluded.

Personalized medicine can be misinterpreted, some believe, to suggest that treatments are being developed on a personal basis for each individual patient, observed Lucy Yates, Ph.D., a specialist registrar in clinical oncology at The Royal Marsden NHS Foundation Trust, a member of the ESMO Translational Research and Personalised Medicine Working Group, in a video posted on YouTube about the Glossary.

“Other people feel that personalized medicine actually reflects the practice of oncology in the everyday clinic. We always take into account patient and tumor characteristics when we make any decision intreating our patients,” Dr. Yates said.  “We hope that this glossary will help to harmonize the language used by clinicians and researchers in the oncology community.”

Founded in 1975, ESMO promotes oncology education and information as the leading European professional organization for medical oncology, with 17,000 members representing oncology professionals from 150 countries worldwide.