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open access (technical)
Abstract
The implementation of cancer genomic
testing into the clinical setting has brought major opportunities.
However, as our understanding
of cancer initiation, maintenance and progression
improves through detailed cancer genomic studies, the challenges
associated
with driver identification and target
classification in the clinical setting become clearer. Here, we review
recent insights
into cancer genomic testing in the clinical
setting, and suggest a target classification approach that considers the
levels
of evidence supporting the prioritization of tumour
drivers for therapeutic targeting in light of complex cancer clonal and
sub-clonal structures and clinical successes and
failures in the field. We argue that such classification approaches,
together
with transparent reporting of both positive and
negative clinical data and continued research to identify the sub-clonal
dynamics
of driver events during the disease course, will
facilitate inter-trial comparisons, optimize patient informed consent
and
provide a critically balanced evaluation of genomic
testing in clinical practice.......
This Article
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Ann Oncol (2014) 25 (12): 2295-2303. doi: 10.1093/annonc/mdu478
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