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Personalized oncology--matching patients with treatments based on measurably objective characteristics--promises to transform cancer treatment, and be the test case for personalized medicine, more broadly. But for those seeking the payoff of longer and better lives for cancer sufferers, as well as the potential competitive advantages and economic gains in a vast and growing market, significant obstacles remain. In this Executive Insights, L.E.K. Consulting outlines the major barriers to realizing the vision of personalized oncology.