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.
TL;DR
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.