Personalized medicine: the enabling role of nanotechnology.
2016 Personalized medicine has recently taken center stage in cancer research and has led to a number of therapeutic success stories in oncological practice. Cancer is an immensely complex, heterogeneous disease that is caused by the interplay of multiple intrinsic (genetic predisposition) and extrinsic (lifestyle) factors. As cancer progresses, genetic drifts in the cell population typically result in heterogeneity with regard to cell antigenicity, differentiation state, proliferation rate, invasiveness, metastatic potential and response to chemotherapeutics. It has been increasingly recognized that cancer is a heterogeneous, evolving and adaptive malady that requires personalization of the treatment, as to the extent where the right drug is administered to the right patient with the right dose at the right time. Given the system complexity and the vastly limited understanding of the underlying pathophysiology, however, this poses a constitutive challenge to modern medicine (multiparameter optimization problem with many unknowns) In recent years, analysis of somatic mutations in cancer genomes has led to the identification of a compendium of aberrations that confer cancer development and has in turn enabled development of drugs that specifically target hallmarks of neoplasia [1] A range of small molecule inhibitors and therapeutic antibodies have been developed to target overexpressed proteins, driving the exceedingly rapid translation of genomic discoveries into clinical end points. Selection of patient subsets (so called responders) out of bigger patient cohorts based on genomic data has proven to be highly beneficial with regard to drug efficacy and patient outcome and has ushered in a new era, the era of precision medicine. Although perceived with much excitement by the scientific community, personalized therapy heavily relies on initial genomic profiling and the constitutive monitoring of biomarkers which require costefficient analysis of massive amounts of data, and hence few personalized medicines have entered clinical routine [2] While a few years back the challenges in this field were scientific in nature, with the maturation of the omics' sciences, it now seems that the major barriers are increasingly related to effective clinical implementation and socioeconomics [3,4] Personalized medicine requires a re thinking and transition away from the 'one drug to fit all' idea. Every day, millions of people take medications that will not only not help but in the worst case even harm them, hence causing a significant burden to the healthcare system. Still, these very same medications are the drugs that reach blockbuster status and bring the revenue that is so vital for a filled drug development pipeline and thus are critiPersonalized medicine: the enabling role of nanotechnology
Nanomedicine