The promises of precision medicine – voices from the Nordics

Precision oncology holds promises for optimized and individualized treatment strategies with positive effects on quality-of-life and improved outcomes.Molecularly matched therapies generally offer a favorable toxicity profile with less fatigue and hematologic toxicities compared to cytotoxic drugs and offer hope for more years with favorable quality-of-life.Next-generation sequencing of tumor tissue, circulating tumor DNA (ctDNA) analyses, gene expression profiling, and whole genome sequencing have to variable degrees been implemented into clinical routine.Stratified precision oncology, based on diagnosis-specific established and validated biomarkers, has evolved into standard of care with challenges largely related to equity of access to molecular diagnostics.Tumor agnostic precision oncology, based on the identification of targetable alterations for off-label use, is being evaluated in a number of national clinical trials that typically include patients with advanced and refractory cancers.Like other new developments, precision oncology experiences challenges in clinical implementation.New analytical technologies allow for rapid, high-throughput and increasingly comprehensive tumor profiling, though access to diagnostics varies geographically and clinical decision-making is challenged by the plethora of biological variants identified.Clinical decision-making is challenged by the small-size patient cohorts and the limited evidence to guide treatment recommendations, which has spurred recruitment of new competences involved in precision diagnostics and treatment, establishment of molecular tumor boards, structures for data sharing and plans for long-term monitoring [1,2].Additionally, guidelines for precision diagnostics and molecular tumor boards and frameworks for clinical decision-making and trial-matching have been developed [3,4].The EU has, through the EU4Health and Horizon Europe programs, funded collaborative initiatives aimed to meet upcoming needs through expanded access to precision oncology, sharing of best practices, development of data sharing models, addressing key barriers such as off-label reimbursement and providing data on cost-effectiveness.These initiatives include the Personalized Cancer Medicine for all EU citizens (PCM4EU), Precision