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. Author manuscript; available in PMC: 2019 Feb 1.
Published in final edited form as: Trends Cancer. 2018 Jan 12;4(2):101–109. doi: 10.1016/j.trecan.2017.12.004

Key Figure 1. The snowflake theory and changing drug development paradigms.

Key Figure 1

Top panel: Cancers are akin to malignant snowflakes: No two snowflakes are identical, and it seems that it is also extremely unusual for two metastatic tumors to have the same genomic fingerprint. As it turns out, if metastatic tumors are akin to malignant snowflakes in their distinctiveness, individual tumors become the ultimate extrapolation of rare and ultra-rare tumors--N-of-one malignancies.

Bottom panel: Moving from drug-centric (top panel) to patient-centric trials and care (middle and bottom panels). If each cancer is unique and complex, precisely targeting it requires personalized combination therapy regimens. Bottom panel shows that personalized therapy is already routine in patient care outside the oncology setting.

Abbreviations: CHF = congestive heart failure; RA = rheumatoid arthritis