Redefining Cancer Classification: A Shift from Organ-based to Molecular-based Approach

The Current Landscape of Cancer Classification and Its Limitations

The conventional method for classifying and treating cancer has primarily focused on the organ in which the tumor originated. This has led to the classification of cancers and the creation of treatment plans based on organ-specific specialties. However, recent developments in precision oncology have revealed a growing divergence between this classification and the molecular profiling of tumors. As a result, patients with tumors expressing high levels of PD-L1 face delays in receiving relevant drugs because clinical trials are conducted sequentially for each disease type.

The organ-based classification of cancer is proving to be a barrier to progress in cancer research. It makes it harder for patients to obtain effective drugs, disrupts medical education, and complicates patient comprehension. Renowned medical oncologist Fabrice André echoed these sentiments, advocating for a shift towards a molecular-based naming system for cancer classification. This approach aims to enhance the current organ-based classification by focusing on the molecular characteristics of cancer.

The Need for a Molecular-based Cancer Classification

The current system of classifying cancer based on the organ of origin is becoming increasingly inadequate. André highlights the limitations of the current system, emphasizing the need for a more precise, biology-based method of naming cancers. Molecular profiling is crucial in guiding therapies and tailoring treatment to the genetic makeup of the patient’s cancer. For instance, molecular features of endometrial cancer (EC) in a Chinese population revealed four subtypes: POLE mut, MMRd, p53abn, and NSMP. The distribution of these subtypes differed from those found in the Caucasian population, thus highlighting the need for a more precise method of cancer classification.

The potential benefits of adopting a molecular-based naming system include faster access to targeted therapies, prioritizing patient care, and reducing confusion. This shift could lead to more effective treatments and improved patient outcomes. A molecular-based classification of cancer would also be beneficial in cases of lung neuroendocrine neoplasms (NENs). The molecular heterogeneity of small cell lung carcinoma and large cell neuroendocrine carcinoma emphasizes the importance of genomic and transcriptomic features in subtyping and treating these tumors.

Implementing a Molecular-based Cancer Classification System

Implementing a molecular-based naming system for cancer classification would require significant changes. Improvements in guidance, restructuring oncology, rethinking education, and improving access to molecular testing are all necessary steps. Considering the advances in molecular classification and targeting of solid tumors in the context of precision medicine and oncology, the importance of molecular diagnosis and tumor targeting in personalized and precision medicine (PPM) cannot be overstated.

The existing organ-based cancer classification is not in sync with the latest developments in precision oncology. It is time to redefine cancer classification and treatment based on the molecular characteristics of the cancer rather than the organ of origin. A move in this direction would be a significant step towards more tailored and effective cancer treatments, ultimately improving patient outcomes.