With the revolution in understanding malignancy supplied by genomic insight, cancer acquires another level of classification, not so much by what part of the body it starts in, but by the molecular mechanism driving the cancer. Perhaps the biggest revelation of genomic medicine is that diseases like colon, stomach, or breast cancer (to name but a few) once thought to represent one disease have many underlying subtypes that respond to different therapies.
Therefore, the one-size-fits-all approach to treatment appears to have been based on an incredibly naive assumption: that for the sake of treatment everyone has the same disease. The truth turns out to be far different. The former view that “Nothing matters much, few things matter at all in cancer” turns out to be a falsehood based in ignorance, chiefly the historical ignorance that until a decade ago there were no clinically or commercially available genomic tests beyond individual markers.
Now we have an explosion of diagnostic options in the clinic fostered by rapid commercialization and the falling cost of the technology. In 2017, whole genome sequencing (WGS) in oncology may emerge for a few thousand dollars. And while not every patient needs WGS, the costs of smaller panels are a small fraction of the cost of the drugs used to treat cancer.