Systems oncology: toward the clinical application of cancer systems biology

How many times do oncologists have to modify treatments due to their inefficacy? And how many times do cancer patients report intense side effects and toxicity of treatment? The answer is obvious: many, many times. Usually, medical decisions are supported by good evidence of effectiveness and benefit [1], but are also based on heuristic approaches. In these situations, physicians try to hit the target using the available therapeutic options taking into account the results of properly designed randomized controlled trials and to manage adverse events. However, the lack of a holistic scientific approach for the defi nition of the right treatment for the right patient (i.e., personalized/precision medicine) based on biological and clinical data is an urgent problem to solve in several areas within medicine, such as psychiatry or oncology. In fact, in oncology, the problem is, if it should be, more complicated because patients and doctors have to take into account the prognostic dimension for each case in particular. However, until a few years ago, the biological sciences, whose knowledge supports medicine (among other applied disciplines), were unable to provide the solution for this problem. With the advent of the new century, the development of high-throughput technologies for bio logical analyses, in particular for bio chemistry and molecular biology, made possible the generation of a huge amount of data from multiple sources (i.e., isolated cells, body fluids, tissues and so on) at mul tiple molecular levels (i.e., genomic, transcriptomic, proteomic and so on). These technical improvements could enable the implementation of a true personalized medicine by the simultaneous analysis of a large number of molecular parameters in each patient and disease. However, the integration of molecular and clinical data for achieving useful and understandable information for the decision-making p rocess is necessary [2]. Systems biology is an emerging discipline that pursues the integration of multiple levels of biological information in order to attain an integral view and deep understanding of physiological processes both in healthy and pathological conditions. Systems biology employs methodological approaches based on mathematics and