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Ron Winslow in Monday's Wall Street Journal offers up a story on cancer research that is bedecked well above the fold by a headline that has been written many, many times before: "Major Shift in War on Cancer." Indeed, there have been major shifts in the war on cancer declared since the war began, back in the Nixon administration, often coinciding with big annual cancer research meetings that attract reporters, like the American Society of Clinical Oncology meeting in Chicago that Winslow attended. (This isn't Winslow's fault, but what kind of story are you going to pitch editors after a cancer meeting: no hope, no news?) Old-timers will recall the interferons, the interleukins, monoclonal antibodies, immune therapy, oncogenes, genomics, angiogenesis, stem cells. All of these were scientifically valid, some even clinically exciting, if prone to hype. But still the war drags on. Winslow's new paradigm is so-called personalized cancer therapies, which is less a single biological tactic than a broader strategy: to step back from an approach that goes after cancer as a single disease caused by a handful of cellular malfunctions, and begin to focus on it as a very individual malady.
As Winslow says, this isn't new; what's new is some clinical evidence that the approach has quantifiable promise. The personalized approach emerges from a long debate within cancer research that often seemed to lay people and some researchers to be absurdly philosophical. Is cancer a homogenous disease that can eventually be "cured" by investigation of fundamental cellular malfunctions, or is it a heterogeneous jumble of tumors and mutations? For decades, the big money went to research that aimed at the homogenous argument: Hypotheses like oncogenes or of "natural" products like the interferons or interleukins in the '80s were driven by the belief -- really the hope -- that there were switches common to all, or at least many, cancers. Even the genome projects of the late '90s were marketed to a broader public as a way to discover the genetic basis of cancer, dangling the hope of a broadly homogenous "cure." (These approaches always raised the most money, which certainly added to their allure.) But in fact, that approach has been battered, as every advance seemed to throw up greater complexities. As Winslow writes: "Many tumors are complex organisms fueled by multiple pathways. When one is disrupted even by a potent single agent, others compensate to help tumors develop resistance to treatment." 
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