Generali D.,Unita Sperimentale Of Patologia Mammaria And Centro Of Medicina Molecolare |
Berruti A.,University of Turin |
Foroni C.,Unita Sperimentale Of Patologia Mammaria And Centro Of Medicina Molecolare |
Bazzola L.,Unita Sperimentale Of Patologia Mammaria And Centro Of Medicina Molecolare |
And 7 more authors.
Journal of the National Cancer Institute - Monographs | Year: 2011
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. © The Author 2011. Published by Oxford University Press. All rights reserved.