Molecular oncology and the neoadjuvant setting: The perfect blend for treatment personalization and clinical trial design

Daniele Generali, Alfredo Berruti, Chiara Foroni, Letizia Bazzola, Daniele Andreis, Giovanni Allevi, Alessandra Bersiga, Luigi Dogliotti, Stephen B. Fox, Adrian L. Harris, Alberto Bottini

Research output: Contribution to journalArticle

Abstract

Breast cancer is a heterogeneous disease. Predictive molecular markers are crucial in patient management, but the only recommended predictive biomarkers are estrogen and progesterone receptors and HER2. There are many new targeted therapies, and although the target pathway expression is readily analyzed on conventional pathology, the dynamic response cannot be assessed and pathway expression is no guarantee it has a major driver role, even if mutated. Selecting therapies requires considering the patient, the molecular characteristics of the tumor, and the microenvironment of the tumor. Thus, the integration of molecular pathology, imaging, and early tumor biological response to therapy may provide evidence of drug activity and allow more rapid changes of therapy. The adaptive response of the tumor is a key resistance mechanism that can be assessed readily in the neoadjuvant setting. Although there are no markers that meet all surrogacy criteria, their use could provide crucial information on mechanisms of drug sensitivity/resistance. Validation of such markers requires a major emphasis on neoadjuvant trials to relate early-biomarker response to outcome.

Original languageEnglish
Pages (from-to)67-70
Number of pages4
JournalJournal of the National Cancer Institute - Monographs
Issue number43
DOIs
Publication statusPublished - Oct 2011

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ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Generali, D., Berruti, A., Foroni, C., Bazzola, L., Andreis, D., Allevi, G., Bersiga, A., Dogliotti, L., Fox, S. B., Harris, A. L., & Bottini, A. (2011). Molecular oncology and the neoadjuvant setting: The perfect blend for treatment personalization and clinical trial design. Journal of the National Cancer Institute - Monographs, (43), 67-70. https://doi.org/10.1093/jncimonographs/lgr029