OBJECTIVES: Since a relatively small proportion of cancer patients have specific markers for which targeted therapies have been proven effective, (only 5% of over 500 tested cancer patients were eligible for such treatments), the present paper examines whether onco-exceptionalism is justifiable or, in other words, if reimbursing highly costly drugs aligns with principles of equity.

METHODS: As a scoping review, the resent paper revisits onco-exceptionalism by first outlining the context of healthcare resource allocation concerning immunotherapeutic treatments for cancer drugs. It then discusses various arguments for and against onco-exceptionalism. Additionally, by revisiting the concept of 4P medicine, the mechanisms that facilitate reimbursement of precision oncology compared to other medical interventions are discussed.

RESULTS: So far precision therapy has been less successful than hoped due to factors related to the complexity of cancer, the methods of testing novel therapies, and the regulatory and clinical translation processes. Precision medicine is still governed by the rule that variation is the norm in biology and there is a limit to its predictive powers.

CONCLUSIONS: We conclude by underlining: (as to the role of citizen-patients) the role of participation- the responsibility of the individual against their own health- in prevention, prediction and precision; the need for a transition from merely treating illness to supporting the healthy in maintaining their well-being; (as to the role of governing agents) demanding transparency regarding R&D costs and end product cost from the pharma industry instead of secrecy. If the medical technology keeps progressing, and precision medicine keeps figuring out new biomarkers and new ways of intervening the progression of cancer, but at the same time obesity also increases or smoking stays a ‘habit’ or small everyday details keep getting ignored, we seem to be barking at the wrong tree and the costs of healthcare will keep escalating.