Classification and Drug Targeting (Personalised Medicine)
Prostate cancer is a clinically and molecularly heterogeneous disease. However no clear classification framework has been developed. The lack of a classification framework represents a major problem for the targeting of new therapies and in the development of personalised medicine. Stratifications have been proposed based on the presence of specific genetic alterations (e.g. ERG, ETV1, ETV4, FLI1, SPOP, FOXA1, and IDH1) and a number of rarer cancer subgroups have been defined (e.g. cribriform carcinoma, basal cell prostate cancer, neuroendocrine prostate cancer).
The clinical utility of these divisions in managing advanced disease is still under investigation, although the tailored targeting of patients with specific classes of genetic alteration (stratified medicine) represents a promising area of investigation. As is illustrated by the use of PARP inhibitors in the treatment of patients harbouring BRCA mutation.
None-the-less there still is an urgent requirement for better classification frameworks that can used to assist targeting of therapies for advanced cancers, and for the development of linked tests that can be applied in the clinic, which we will consider funding.