In a recent paper in Nature Reviews Cancer, Maley et al set out to define a consensus framework for classifying neoplasms. The paper’s premise is that such a theoretical framework is a necessary first step for developing new quantitative approaches. I disagree. I argue that the paper highlights the limited practical relevance of a purely intellectual exercise. Solid classification frameworks of clinical relevance need more detail and need to be grounded on applicability to real data in clinical practice.
For those of you in hurry, let me sum up what my claims are:
- This is a very good review of the field. Its particular strength is combining cancer evolution with the tissue microenvironment. You should definitely read it.
- However, the review poses as something it is not: a classification scheme of clinical relevance.
- The proposed classification scheme fails because (a) there is no practical way how to classify patients with it, and (b) evidence of clinical impact is circumstantial and anecdotal.
- The authors recognise all these problems, but dismiss them as areas of future research, rather than testing prototypes of their scheme on real data.
- Methodological and measurement innovations happen as we speak – no one needed this framework to kick start innovation.
- Consensus on specific approaches will be much harder, much more interesting and much more useful, than consensus on lofty ideas.