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Personalization of treatment based on biological markers is being utilized in clinical medicine with increasing frequency. This trend, despite an effort to identify possible common patterns, reflects the reality that no two patients are alike, and no single clinical course is identical; not even within a group of seemingly similar patients. There are numerous clinical variations related to host or environment-dependent factors. Numerous examples of these interpersonal differences have been recognized with drugs such as pain-control medications, heart medications, or antimicrobials. The differences have been attributed to increased pharmacometabolic capacity, to different individual microbiomes and to genetic differences between individuals (2). The latter has led to development of an entirely new specialty—pharmacogenomics. While this clinical heterogeneity is well-appreciated in most major medical specialties, clinical oncology seems to represent, surprisingly enough, one of the exceptions.