[gdpawel]

Both genomics and proteomics can identify potential therapeutic targets for drugs, but these targets require the determination of cellular endpoints for clinical responses. You still need to measure the net effect of all processes within the cancer, acting with and against each other in real time, testing living cells actually exposed to drugs and drug combinations of interest, and not just the individual molecular targets.

The core understanding is the cell, composed of hundreds of complex molecules that regulate the pathways necessary for vital cellular functions. If a targeted drug could perturb any of these pathways, it is important to examine the effects of drug combinations within the context of the cell.

Cancer cells have many mutations in many different pathways, so even if one route or two is shut down by a targeted treatment, the cancer cell may be able to use other routes. Molecular diagnostics often have been mostly or totally ineffective at identifying clinical responders to the various therapies.

It cannot discriminate among the activities of different drugs within the same class. Instead, it assumes that all drugs within a class will produce precisely the same effect, even though from clinical experience, this is not the case. Nor can it tell us anything about drug combinations. Cancer is a complex disease and needs to be attacked on many fronts.