The Sad Truth About “Standard” Cancer Treatment

Why Testing Before Treatment can change everything

If you or someone you love has just heard the word cancer, the next question usually comes fast:

“What do we do next?”

Most patients assume the answer will be precise. Personalized. Calculated.

But here’s the uncomfortable truth: many cancer patients still begin treatment with a “generalized” plan—a protocol based on what worked for other people with a similar cancer type, stage, or appearance under a microscope.

And in far too many cases, that first treatment doesn’t work well enough—or doesn’t work at all.

That means the patient pays the price twice:

Time is lost while the cancer continues to grow or spread
Side effects accumulate from treatments that weren’t the right match
Options can narrow as the disease evolves and becomes harder to control

This is exactly why one idea is becoming impossible to ignore:

“Testing Before Treatment” should be a first step in the cancer journey

Cancer isn’t one disease. It’s a category of diseases—and even two patients with the “same” cancer diagnosis can have tumors that behave very differently.

Why? Because each tumor has its own biology:

Different mutations
Different growth signals
Different resistance mechanisms
Different interactions with the immune system

That’s why response rates to traditional treatments vary widely and initial treatments only work about half the time, and why many patients don’t achieve the response they need from initial therapy—especially with cytotoxic chemotherapy across many cancer types. Palliative Care Network of Wisconsin+1

So if cancers are different… why do so many patients start with the same playbook?

Because without advanced testing, doctors are often forced into a “best guess”

Oncologists are highly trained, and they’re working with the information available. But if the only data you have is:

a diagnosis name (“lung cancer”)
a stage (“stage III”)
a tumor grade (“aggressive”)
and a standard-of-care guideline pathway

…then treatment becomes an educated probability game.

And probability is not the same as precision.

The goal is simple: increase the odds of getting the right treatment the first time

“Testing Before Treatment” means using the patient’s own cancer biology to guide decisions early—before valuable time is lost.

There are three major categories of advanced pre-treatment testing that can dramatically improve clarity and confidence:

1) Treatment Effectiveness Testing

Ex-vivo drug testing (functional testing)

What it is:
Treatment Effectiveness Testing (often performed using patient-derived cancer cells or organoids) exposes your living tumor cells to a wide panel of therapies—sometimes including hundreds of FDA-approved drugs and combinations—to see which options actually damage or kill your cancer cells outside the body.

Why this matters:
Because cancer treatment is often chosen based on population outcomes (“this works for many patients like you”). Ex-vivo testing asks a more direct question:

“What works on your cancer?”

This approach is an active area of precision oncology research and is increasingly used in specialized settings. Reviews and studies describe how patient-derived organoids and ex-vivo testing can help assess drug sensitivity and support individualized therapy decisions. ScienceDirect+2PubMed+2

What it can help with:

Finding therapies that show stronger tumor-cell kill signals
Identifying likely resistance early
Exploring options when standard treatment has failed or the cancer is advanced
Supporting smarter second-line (or earlier) decisions

A key reality to understand:
Ex-vivo testing is not yet universally available everywhere, and it may be offered through specialized labs, academic centers, or clinical trials depending on cancer type and location. Still, the concept is powerful: test first, treat smarter.

2) Genomic Testing

Tumor DNA / RNA profiling for precision medicine

What it is:
Genomic testing examines tumor DNA (and sometimes RNA) to identify mutations and molecular changes driving the cancer. That information can:

reveal targetable mutations
connect patients to precision therapies
and help match patients to clinical trials

This isn’t theoretical. Comprehensive genomic profiling is increasingly emphasized in modern oncology, especially for advanced or metastatic disease. Studies suggest that doing genomic profiling earlier (before standard therapy in some contexts) can be clinically beneficial by guiding subsequent therapy choices. JAMA Network+1

Why this matters:
Because sometimes the “real” cancer story is hidden at the molecular level.

Two tumors can look similar under a microscope and behave completely differently because their internal signaling is different. Genomic testing helps answer:

What’s fueling the cancer?
Is there an approved targeted therapy for this?
Is there a trial designed for this mutation?

And it’s not just about drugs.
Genomics can also inform prognosis, help anticipate resistance, and reduce wasted steps in the treatment journey.

3) Immunotherapy Response Testing

Biomarkers that predict whether immunotherapy is likely to help

What it is:
Immunotherapy can be life-changing for some patients—and ineffective for others. That’s why biomarker testing matters.

Common immunotherapy-related biomarkers include:

PD-L1 expression
Microsatellite instability / mismatch repair deficiency (MSI-H / dMMR)
Tumor mutational burden (TMB)

These markers are widely discussed in the immunotherapy literature as tools for predicting response to immune checkpoint inhibitors in various cancers. PMC+2Annals of Oncology+2

Why this matters:
Immunotherapy isn’t “better chemo.” It’s a different mechanism—one that depends on your immune system and how your tumor interacts with it.

So testing aims to answer:

Is your tumor visible to the immune system?
Is the immune system already trying (and being blocked)?
Do you have signals that suggest checkpoint inhibitors may work?

Important note:
Even with biomarkers, response is not guaranteed—but testing can help avoid blind trial-and-error and move faster toward the best-fit options.

Why cryopreservation matters

Because you may only get one shot at the best sample

Here’s something most patients are never told:

Your biopsy tissue is incredibly valuable.
It can determine not just today’s treatment—but your options tomorrow.

And how that tissue is preserved matters.

FFPE vs. cryopreservation (in plain English)

FFPE (formalin-fixed, paraffin-embedded) is the traditional method. It’s excellent for routine pathology and many forms of genomic testing.
Cryopreservation preserves tissue at very low temperatures in a way that can help retain higher-quality biomolecules and, in some approaches, tissue viability.

For example:

Research shows cryopreserved tumor material can be viable and useful for advanced applications including ex vivo drug testing. Nature+1
Studies also discuss differences in sample quality and downstream molecular performance between cryopreserved/frozen tissue and FFPE in certain contexts. MDPI+1

The practical patient takeaway

Some advanced testing approaches—especially those requiring living cells (like organoid-based functional drug testing)—generally can’t be done from FFPE because FFPE tissue is fixed and not viable.

So if you don’t preserve tissue appropriately upfront, you may lose access to:

certain functional testing paths
certain deeper exploratory assays
and sometimes eligibility for research protocols that prefer fresh/frozen viable tissue

That’s why patients should ask their doctor directly about cryopreservation options before the biopsy or surgery whenever possible.

“But aren’t these tests expensive?”

Some are. Some aren’t.

Many guideline-aligned biomarker tests (especially in advanced disease) are commonly ordered and often covered, though coverage varies by insurer, cancer type, and clinical scenario. And even when testing is not fully covered, the cost of not testing can be far higher:

weeks or months lost
avoidable toxicity
disease progression
missed trial windows

The core question becomes:

Is it worth testing first to reduce the chances of choosing the wrong first treatment?

For most patients, the answer is yes.

What you should ask your doctor

Bring these questions to your next appointment:

“What tests can we do before treatment to personalize the plan?”
“Are we doing comprehensive genomic profiling? If not, why?” JAMA Network+1
“Are immunotherapy biomarkers like PD-L1 / MSI / TMB relevant for my cancer?” Annals of Oncology+1
“Is there any form of functional testing (ex-vivo drug sensitivity) available for my case?” ScienceDirect+1
“Can we preserve additional tissue for future testing?”
“Is my tissue being saved in a way that supports future advanced testing or trials?” Nature+1
“How much tissue do we have, and how is it being stored?”
“If the first treatment doesn’t work, what’s Plan B—and what data will guide it?”
“Are there clinical trials I should qualify for now, before treatment starts?”
“Can you refer me to a center or lab that offers more advanced testing options?”

The bottom line

Cancer is urgent. But rushing into treatment without the best information can be a painful mistake.

Testing Before Treatment is about replacing guesswork with evidence—so you can:

move faster toward the most effective therapies
avoid unnecessary side effects
preserve options for the future
and fight with a plan built around your cancer, not someone else’s

If you remember one thing, remember this:

You have the right to ask for advanced testing.
You have the right to ask how your tissue is preserved.
And you have the right to pursue the most informed path forward.

1 in 3 Americans Will Get Cancer & 1 in 2 Will Get the Wrong Treatment