“Personalized medicine” has rapidly evolved from connoting cutting-edge thinking about medical care based on individualized need to something of a cliché; everyone wants to focus on personalized medicine these days. At its core, the concept suggests that treatments could be tailored to the health needs of a given person, based on extensive and detailed understanding of the underlying biology of their disease, their intrinsic body function, and the dynamics of whatever intervention is planned. In oncology, the concept is most often linked to 2 particular aspects of personalization: use of gene expression arrays to define which cancer subset most closely describes the tumor, and use of the patient's gene profile to understand either why this cancer developed or how best to treat it.
Breast cancer serves as a model disease for those seeking to develop personalized medicine in oncology. The use of biomarkers and gene expression profiling has yielded important insights into the heterogeneity of breast cancers. We now speak not of “breast cancer” as one monolithic tumor type, but of important, recognizable, definable subsets such as “HER2-positive” breast cancer, “triple-negative” breast cancer, or “ER-positive breast cancer.” Further personalization emerges in treatment algorithms. In particular, the ER-positive tumor types are being splintered into subgroups with different treatment needs.
Tumor-based gene expression analyses, such as the OncotypeDX recurrence score, are used to gauge which patients with ER-positive breast cancer should have chemotherapy and which should not. Finally, breast cancer treatment holds the one instance of pharmacogenomic significance in all of cancer...
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Harold J. Burstein, MD, PhD, editor-in-chief of JNCCN, is an Associate Professor of Medicine at Harvard Medical School and a medical oncologist at Dana-Farber Cancer Institute and Brigham & Women's Hospital. He is a clinician and clinical investigator specializing in breast cancer.
Dr. Burstein attended Harvard College and earned his MD at Harvard Medical School, where he also earned a PhD in immunology. He trained in internal medicine at Massachusetts General Hospital and was a fellow in medical oncology at Dana-Farber before joining the staff. Dr. Burstein's clinical research interests include novel treatments for early- and advanced-stage breast cancer and studies of quality of life and health behavior among women with breast cancer. He has written widely on breast cancer in both traditional medical journals and on the web, including New England Journal of Medicine and Journal of Clinical Oncology.
International committees focusing on cancer treatments that he has or continues to participate in include the NCCN Clinical Practice Guidelines Breast Cancer Panel, St. Gallen Breast Cancer Panel, CALGB Breast Cancer Committee, ASCO Health Services Research and Clinical Research Committees, the National Quality Forum Breast Cancer Technical Panel, and other ASCO expert panels.