Personalised treatment in oncology is based on the principle that the same protocol should not be applied to every patient with cancer. Although cancer may appear to be a similar disease when it develops in the same organ, it in fact presents significant differences in terms of cellular behaviour, growth rate, interaction with surrounding tissues, potential for spread, and response to treatment. This is why modern oncology no longer focuses solely on the location of the tumour but also examines its biological identity. The stage of the disease, the pathological subtype, the genetic profile, the biomarkers, as well as the patient's age, associated conditions, and general health are all assessed together. The aim is no longer to apply a standard treatment to everyone but to define the most effective therapeutic strategy for each individual patient. This approach seeks to maximise treatment effectiveness whilst reducing unnecessary adverse effects.
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Personalised treatment is not limited to targeted therapies determined by advanced testing. It also encompasses decisions such as the need for surgery, its timing, the role of chemotherapy, the indication and extent of radiotherapy, eligibility for immunotherapy, and the frequency of follow-up. It is therefore unsurprising that two patients with the same type of cancer may receive entirely different treatment plans. In some cases, the biology of the tumour calls for a more aggressive approach, whilst in others, a more measured strategy is preferable. The fundamental principle of this approach is to understand the disease not merely by its name but by its behaviour. This reflects a major evolution in oncology, where therapeutic decisions now rest on more precise data, in-depth analyses, and multidisciplinary collaboration.
How Does Genetic Analysis of the Tumour Change the Treatment?
Genetic analysis of the tumour makes it possible to identify the molecular alterations present in the cancerous cells, such as mutations, gene fusions, or certain amplifications. This information directly influences therapeutic decisions. Certain genetic abnormalities make tumour cells particularly responsive to specific treatments, whilst others may be associated with resistance to conventional therapies. Two tumours located in the same organ can thus present very different molecular profiles, which justifies distinct therapeutic approaches. In some patients, a targeted therapy may deliver significant results, whereas in others, chemotherapy or immunotherapy will be more suitable.
Genetic analysis also helps to avoid unnecessary or ineffective treatments. When a medication is only effective in patients who present a specific biological abnormality, it is essential to verify the presence of this target before beginning treatment. Furthermore, certain genetic alterations can predict resistance to particular therapies, which helps to organise the sequence of treatments more effectively. These analyses are not only useful at the time of the initial diagnosis but also in cases of disease progression or treatment resistance, in order to identify new therapeutic options. Today, genetic analysis has become an essential pillar of care in modern oncology.
In Which Cases Are Molecular Tests Carried Out?
Molecular tests are not carried out routinely in every patient but are indicated according to the type of cancer, its stage, its pathological characteristics, and the therapeutic options available. They are particularly important in cancers for which targeted therapies or immunotherapies exist. This is notably the case for certain lung, breast, and colon cancers, melanoma, ovarian cancer, and certain haematological malignancies. However, the decision to carry out these tests also depends on the clinical situation. They may be requested at the time of diagnosis in order to guide the choice of treatment, or at a later stage, in the event of an insufficient response or disease progression.
The use of molecular tests must always be justified by their potential impact on the patient's care. The aim is not merely to produce biological data but to use them in a relevant manner to improve treatment. In certain early-stage cancers, these tests make it possible to assess the risk of recurrence and the need for additional treatment. In advanced forms, they directly guide the choice of medication. Furthermore, in younger patients, those with a family history, or those with an atypical course of the disease, more in-depth analyses may be necessary. The decision to carry out a molecular test therefore rests on an individualised assessment aimed at bringing genuine benefit to the patient.
Why Are Different Treatments Applied for the Same Type of Cancer?
The application of different treatments for the same type of cancer is explained by the considerable complexity of this disease. Two patients with cancer of the same organ may present major differences in terms of stage, histological subtype, rate of progression, lymph node involvement, presence of metastases, genetic profile, and interaction with the immune system. All of these elements directly influence the choice of treatment. In some patients, surgery is the first step, whilst in others, systemic treatment takes priority. One tumour may be responsive to a targeted therapy, whereas another will require chemotherapy. Immunotherapy can be highly effective in certain cases but less relevant in others.
The characteristics specific to the patient also play a determining role in the therapeutic decision. Age, cardiac and renal function, chronic conditions, general health, and previous treatments all strongly influence the medical choices made. An intensive approach may be suited to some patients, whilst a more balanced and better-tolerated strategy will be preferred for others. Furthermore, the objectives of the treatment can vary according to the situation. In some cases, the primary aim is to prolong survival, whilst in others, the priority is to preserve quality of life. The diversity of treatments for the same type of cancer therefore does not represent a contradiction but rather reflects a deeper understanding of the disease and a more precise adaptation to the needs of each patient.