Jul 01, 2022
By Geraldine Carroll, ASCO Publishing
When the online journal JCO Precision Oncology (JCO PO) launched 5 years ago, its scope and vision was set to advance the science and practice of precision oncology and define genomics-driven clinical care of patients with cancer.
“In our first 5 years, we’ve impacted both the study and the practice of precision oncology and been able to highlight both successes and remaining challenges in the field, helping us to focus on areas for future study,” said founding editor-in-chief James M. Ford, MD, FASCO, of Stanford Medicine. The journal’s ability to scientifically and critically evaluate progress in the field and to highlight where future efforts should be focused is among JCO PO’s accomplishments to date.
With 870 published articles and more than 6,500 citations to these articles since 2017, the journal has captured this focused area of oncology through histology-independent, biomarker-integrated clinical cancer research in the form of original research, case reports, opinions, and editorials. Recently, JCO PO received the much-coveted inclusion in Medline indexing. Dr. Ford noted that this will improve access to the published work and the journal’s ability to recruit high-quality articles from authors wanting to be published in a journal and listed on Medline.
Setting the Standard for the Next Generation of Studies
The first 5 years of the journal saw an exciting time in cancer care when, Dr. Ford noted, there was “strong proof of principle of the approach of profiling tumors in an individual way to advance therapies,” while also identifying the great challenges in that area where more work needs to be done.
Reflecting on the impactful content published in the journal, Dr. Ford highlighted several compelling groups of articles, including a series on liquid biopsies and the promise and challenges of approaches such as circulating tumor DNA, circulating tumor cells, proteomics, and other predictive or prognostic factors in the context of molecularly targeted cancer therapies and as tumor markers for early detection and screening.
He also highlighted a special series on novel statistical methods in evaluating clinical trials in precision oncology that provided tutorials to increase awareness among clinical researchers of the different statistical questions and new approaches for discovery, development, and patient care in the precision oncology era.
The Molecular Tumor Board (MTB) Case Discussion series was unique to the journal and highlighted the actual process and discussions that occur at academic MTBs. “These are articles that use a case or a group of cases to represent how a molecular tumor board works; how it uses the genomics reports but also integrates expert opinion in a multi-investigator evaluation of a case to go beyond what an individual test might suggest,” said Dr. Ford. “It’s a way to illustrate to practitioners how useful this process is. These are not the kind of analyses that are often found in the literature, so they are very helpful to understand how the process works.”
Addressing Equity in the Era of Precision Medicine
Addressing access barriers to advanced diagnostics is a major challenge in precision medicine. JCO PO published a special series that explored the complex relationships between health disparities, genetics, and social determinants of health. The articles focus on the intersection of these areas and implications for equity in precision medicine, including the need for diversity in genomics research and clinical trials. The content also addressed barriers to risk-reducing interventions for hereditary cancer syndromes and the need for consistent terminology for and awareness of genetic testing for cancer.
“Like all emerging new medical treatments and fields, patient access to testing and receiving sophisticated genomic analyses is a significant issue, but also to laboratory interpretation and expert opinion of those tests,” Dr. Ford said. “Often, it’s very difficult to apply the results of these tests in isolation. The process of consultation and access to a molecular tumor board evaluative unit is critical given global challenges around health care equity and financial needs.”
Developing Sophisticated Approaches to Profiling Tumors
Dr. Ford believes that “great challenges in coming years will include how to rationally combine targeted therapies in a genomically driven way to be more successful and more predictably effective,” he said. In addition, incorporating molecular profiling in the diagnosis and management of early-stage cancers will be a key area of study, and JCO PO is planning an upcoming special series devoted to this subject.
The next generation, he added, will use more sophisticated approaches to profiling tumors beyond simply sequencing DNA and a more directed way of using biomarkers to try to be predictive about who will experience a response. Ultimately, the field will “try to move this from a research-based, translational area in clinical medicine to one having broader applicability; to both be able to provide better effective care broadly and benefit more people,” he said.
Dr. Ford is encouraged that precision oncology is advancing beyond being a research-intensive focus on an individual patient, to being a clinical approach that is one of many and that is understandable and accessible to physicians globally. This, he believes, will enable the field to help patients with cancer equitably, allowing each patient to receive the benefits of precision oncology, while also understanding for whom such approaches may not be helpful, thus focusing time and resources on those areas needing other novel therapeutic paradigms.
Dr. Ford expressed particular appreciation for the many authors, reviewers, and editorial board members whose contributions have made the journal a success, as well as the patients who have been involved in this developing field. “Our team of associate editors and editorial board members are outstanding and are rising stars in the area of precision oncology,” he said. “Their hard work and commitment have hugely impacted JCO PO in its first 5 years.”