Future crafting in the genomic era
Series: Inscriptions

What does it mean to personalise cancer medicine? Personalised cancer medicine explores this question by foregrounding the experiences of patients, carers and practitioners in the UK. Drawing on an ethnographic study of cancer research and care, we trace patients’, carers’ and practitioners’ efforts to access and interpret novel genomic tests, information and treatments as they craft personal and collective futures. Exploring a series of case studies of diagnostic tests, research and experimental therapies, the book charts the different kinds of care and work involved in efforts to personalise cancer medicine and the ways in which benefits and opportunities are unevenly realised and distributed. Investigating these experiences against a backdrop of policy and professional accounts of the ‘big’ future of personalised healthcare, the authors show how hopes invested and care realised via personalised cancer medicine are multifaceted, contingent and, at times, frustrated in the everyday complexities of living and working with cancer. Tracing the difficult and painstaking work involved in making sense of novel data, results and predictions, we show the different futures crafted across policy, practice and personal accounts. This is the only book to investigate in depth how personalised cancer medicine is reshaping the futures of cancer patients, carers and professionals in uneven and partial ways. Applying a feminist lens that focuses on work and care, inclusions and exclusions, we explore the new kinds of expertise, relationships and collectives involved making personalised cancer medicine work in practice and the inconsistent ways their work is recognised and valued in the process.

Anne Kerr, Choon Key Chekar, Emily Ross, Julia Swallow, and Sarah Cunningham-Burley

). One key area of consideration is patients’ involvement in novel kinds of adaptive clinical trials that create moral, epistemic and commercial value through the continual negotiation of best possible futures for patients as individuals and as a collective (Montgomery 2017a; 2017b ). We investigate the rise of ‘experimental patients’ in molecular oncology; patients who are actively involved in crafting treatment regimes together with healthcare professionals, including as research participants. We will also explore how patients, including

in Personalised cancer medicine
Adaptive trials for intractable cancers
Anne Kerr, Choon Key Chekar, Emily Ross, Julia Swallow, and Sarah Cunningham-Burley

. As we discussed in Chapter 1 , randomised control trials (RCTs), the ‘gold standard’ of evidence-based medicine, have been superseded by what Keating and Cambrosio ( 2011 ) describe as a ‘new style of practice’ in medical oncology, based on large trials across multiple sites to develop targeted therapies for subtypes of cancers based on genomic profiling. Multi-arm trials test several different treatments at once. If a particular drug is not proving efficacious the trial arm can be closed and new treatment arms brought in (Medical Research Council 2014 ; West

in Personalised cancer medicine
Prolonging foreshortened futures
Anne Kerr, Choon Key Chekar, Emily Ross, Julia Swallow, and Sarah Cunningham-Burley

feasibility study (which we are calling VGT), setting out the negotiations around evidence performed in this experimental space. Precision oncology for advanced gynaecological cancers A swell of activism has recently grown around gynaecological cancers, historically regarded as a ‘Cinderella cancer’ (Jasen 2009 ). Gynaecological cancers, including womb (uterine and endometrial), ovarian, cervical, vulval and vaginal cancer, are more common in post-menopausal women in the UK, with the exception of cervical cancer, which tends to

in Personalised cancer medicine
Open Access (free)
Exploring personalised cancer medicine
Anne Kerr, Choon Key Chekar, Emily Ross, Julia Swallow, and Sarah Cunningham-Burley

The focus of our study has been on genomics, the branch of molecular medicine concerned with mapping genomic profiles, and how this is reshaping cancer medicine and the experience of cancer. This has included diagnostic and predictive tests for cancer based on molecular profiling (shifting from single genes to panels of genes to whole genome and next generation sequencing); treatments targeted at cancers with particular molecular signatures (sometimes called tailored treatments or precision oncology); clinical trials of these new diagnostics and treatments

in Personalised cancer medicine