We say we are in an era of precision medicine. But what can one do when the very information needed to make these informed, directed, personalized choices cannot be accessed by the clinician? Well, that is the situation we currently face as ocular oncologists for retinoblastoma (Rb).
Despite critical advances in how chemotherapy is delivered, worldwide nearly 50 percent of advanced eyes with Rb are enucleated and many more affected eyes are legally blind – even with treatment (1)(2). Why? Because there are no known molecular prognostic features that can predict the response of Rb to treatment and clinical features rely primarily on assessing the size of the tumor or presence of seeding (e.g., Group Classification); however, they still predict with only 50 percent certainty whether an advanced Group D Rb tumor will respond to intravenous chemotherapy or will require subsequent enucleation due to persistent or recurrent tumor. In 2017, for advanced eyes, we have the same predictive value as a coin flip (3).
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