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Retrospective observational study of HER2 immunohistochemistry in borderline breast cancer patients undergoing neoadjuvant therapy, with an emphasis on Group 2 (HER2/CEP17 ratio ≥2.0, HER2 copy number <4.0 signals/cell) cases. Br J Cancer 2021; 124:1836-1842. [PMID: 33762723 PMCID: PMC8144199 DOI: 10.1038/s41416-021-01351-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The ASCO/CAP guidance on HER2 testing in breast cancer (BC) has recently changed. Group 2 tumours with immunohistochemistry score 2+ and HER2/CEP17 ratio ≥2.0 and HER2 copy number <4.0 signals/cell were re-classified as HER2 negative. This study aims to examine the response of Group 2 tumours to neoadjuvant chemotherapy (NACT). METHODS 749 BC cases were identified from 11 institutions. The association between HER2 groups and pathological complete response (pCR) was assessed. RESULTS 54% of immunohistochemistry HER2 positive (score 3+) BCs showed pCR, compared to 19% of immunohistochemistry 2+ FISH amplified cases. 27% of Group 2 treated with HER2 targeted therapy achieved pCR, compared to 19 and 11% in the combined Groups 1 + 3 and Groups 4 + 5, respectively. No difference in pCR rates was identified between Group 2 and Group 1 or combined Groups 1 + 3. However, Group 2 response rate was higher than Groups 4 + 5 (p = 0.017). CONCLUSION No difference in pCR was detected in tumours with a HER2/CEP17 ratio ≥2.0 and a HER2 score 2+ by IHC when stratified by HER2 gene copy number. Our data suggest that ASCO/CAP HER2 Group 2 carcinomas should be evaluated further with respect to eligibility for HER2 targeted therapy.
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Liang X, Li H, Coussy F, Callens C, Lerebours F. An update on biomarkers of potential benefit with bevacizumab for breast cancer treatment: Do we make progress? Chin J Cancer Res 2019; 31:586-600. [PMID: 31564802 PMCID: PMC6736652 DOI: 10.21147/j.issn.1000-9604.2019.04.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As the first monoclonal antibody against vascular endothelial growth factor (VEGF), bevacizumab (BEV) is a definitely controversial antiangiogenic therapy in breast cancer. The initial excitement over improvements in progression-free survival (PFS) with BEV was tempered by an absence of overall survival (OS) benefit and serious adverse effects. Missing targeted population urged us to identify the predictive biomarkers for BEV efficacy. In this review we focus on the research in breast cancer and provide recent investigations on clinical, radiological, molecular and gene profiling markers of BEV efficacy, including the new results from randomized phase III clinical trials evaluating the efficacy of BEV in combination with comprehensive biomarker analyses. Current evidences indicate some predictive values for genetic variants, molecular imaging, VEGF pathway factors or associated factors in peripheral blood and gene profiling. The current challenge is to validate those potential biomarkers and implement them into clinical practice.
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Affiliation(s)
- Xu Liang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.,Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, Paris 75005, France
| | - Huiping Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris 75005, France
| | - Celine Callens
- Pharmacogenomic Unit, Department of Genetics, Curie Institute, PSL Research University, Paris 75005, France
| | - Florence Lerebours
- Department of Medical Oncology, Institut Curie, René Huguenin Hospital, Saint-Cloud 92210, France
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3
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Ma X, Wang X, Huang J, Chen Y, Zhang J, Zhang B, Shi C, Liu L. Bevacizumab Addition in Neoadjuvant Treatment Increases the Pathological Complete Response Rates in Patients with HER-2 Negative Breast Cancer Especially Triple Negative Breast Cancer: A Meta-Analysis. PLoS One 2016; 11:e0160148. [PMID: 27579484 PMCID: PMC5006981 DOI: 10.1371/journal.pone.0160148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/14/2016] [Indexed: 02/05/2023] Open
Abstract
Background Neoadjuvant therapy is administered to breast cancer patients as an induction process before surgery or radiotherapy to reduce tumor size. Human epidermal growth factor receptor-2 (HER-2) negative breast cancer lacks effective standard target therapy. Bevacizumab has a controversial role in the treatment of breast cancer and we conduct a meta-analysis to evaluate the value of adding bevacizumab in neoadjuvant regimen. Methods Potentially eligible studies were retrieved using PubMed, EMBASE and Medline. Clinical characteristics of patients and statistical data with pathological complete response (pCR) data were collected. Then a meta-analysis model was established to investigate the correlation between administration of bevacizumab in neoadjuvant therapy and pCR rates in HER-2 negative breast cancer. Results Seven eligible studies and 5408 patients were yielded. The pCR rates for “breast” or “breast plus lymph node” were similar. In subgroup analysis, we emphasized on patients with triple-negative breast cancer (TNBC). In the criterion of “lesions in breast” the pooled ORs was 1.55 [1.29, 1.86], P<0.00001 and regarding to the evaluation criterion of “lesions in breast and lymph nodes”, the pooled ORs was 1.48 [1.23, 1.78], P<0.0001, in favor of bevacizumab administration. Conclusion According to our pooled results, we finally find that bevacizumab addition as a neoadjuvant chemotherapy component, for induction use with limited cycle to improve the pCR rates and patients may avoid long-term adverse event and long-term invalid survival improvement. Especially in subgroup analysis, pCR rates could be improved significantly and physicians could consider bevacizumab with caution. As patients could avoid the adverse event caused by long-term using of bevacizumab, long-term quality of life improvement may be achieved, especially in TNBC.
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Affiliation(s)
- Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoshan Wang
- Department of Clinical Oncology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Jingwen Huang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingtai Chen
- Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Collage, Beijing, China
| | - Jing Zhang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Binglan Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Changle Shi
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Liu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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4
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Moreno-Muñoz D, de la Haba-Rodríguez JR, Conde F, López-Sánchez LM, Valverde A, Hernández V, Martínez A, Villar C, Gómez-España A, Porras I, Rodríguez-Ariza A, Aranda E. Genetic variants in the renin-angiotensin system predict response to bevacizumab in cancer patients. Eur J Clin Invest 2015; 45:1325-32. [PMID: 26509357 DOI: 10.1111/eci.12557] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, there are no predictive biomarkers for anti-angiogenic strategies in cancer, but response to anti-angiogenic drugs is associated with development of hypertension secondary to treatment. Therefore, this study explored the clinical relevance of genetic polymorphisms in some components of the renin-angiotensin system (RAS). MATERIAL AND METHODS Genomic DNA was isolated from peripheral blood from 95 metastatic breast or colorectal cancer patients treated with bevacizumab, and AGTR1-A1166C (rs5186), AGT-M235T (rs699) SNPs and ACE I/D (rs4646994) polymorphisms were genotyped using RT-PCR. Circulating vascular endothelial grow factor and angiotensin converting enzyme (ACE) levels were analysed using ELISA kits. The antitumoral activity of bevacizumab was assayed in mice orthotopically xenografted with AGTR1-overexpressing breast cancer cells. RESULTS The ACE IN/IN genotype was associated with a higher rate of disease progression compared to DEL/IN and DEL/DEL genotypes (36% vs. 11·1% P < 0·05). Similarly, AGTR1-1166A/A genotype was also associated with a higher rate of disease progression compared to AGTR1-1166A/C and AGTR1-1166C/C genotypes (24·4% vs. 2·7% P < 0·01). ACE IN/IN genotype was also found to be associated with shorter time to treatment failure compared to ACE IN/DEL and ACE DEL/DEL genotypes (14 weeks vs. 41·71, P = 0·033), whereas circulating ACE levels were found to be associated with a better response to bevacizumab treatment. Besides, in vivo experiments showed a significantly higher antitumoral activity of bevacizumab in tumours derived from AGTR1-overexpressing breast cancer cells. CONCLUSIONS A higher activity of ACE-angiotensin-II-AGTR1 axis is associated with a better response to bevacizumab, supporting that the RAS can be an important source of potential predictive markers of response to anti-angiogenic drugs.
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Affiliation(s)
- Diana Moreno-Muñoz
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Juan R de la Haba-Rodríguez
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Francisco Conde
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Laura M López-Sánchez
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Araceli Valverde
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Vanessa Hernández
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Antonio Martínez
- Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain.,Clinical Analysis Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
| | - Carlos Villar
- Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain.,Pathology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
| | - Auxiliadora Gómez-España
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Ignacio Porras
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Antonio Rodríguez-Ariza
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
| | - Enrique Aranda
- Oncology Department, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Reina Sofía, University of Córdoba, Córdoba, Spain.,Spanish Cancer Network (RTICC), Instituto de Salud Carlos III, Córdoba, Spain
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Marous M, Bièche I, Paoletti X, Alt M, Razak A, Stathis A, Kamal M, Le Tourneau C. Designs of preoperative biomarkers trials in oncology: a systematic review of the literature. Ann Oncol 2015; 26:2419-28. [DOI: 10.1093/annonc/mdv378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/19/2015] [Indexed: 01/06/2023] Open
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Manso L, Moreno F, Márquez R, Castelo B, Arcediano A, Arroyo M, Ballesteros AI, Calvo I, Echarri MJ, Enrech S, Gómez A, González Del Val R, López-Miranda E, Martín-Angulo M, Martínez-Jañez N, Olier C, Zamora P. Use of bevacizumab as a first-line treatment for metastatic breast cancer. ACTA ACUST UNITED AC 2015; 22:e51-60. [PMID: 25908921 DOI: 10.3747/co.22.2210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE During clinical practice, it can be challenging, given the lack of response biomarkers, to identify the patients with metastatic breast cancer (mbca) who would benefit most from the addition of bevacizumab to first-line standard chemotherapy. The aim of the present review was to summarize the relevant scientific evidence and to discuss the experience of a group of experts in using bevacizumab to treat mbca. METHODS A panel of 17 Spanish oncology experts met to discuss the literature and their experience in the use of bevacizumab as first-line treatment for mbca. During the meeting, discussions focused on three main issues: the profile of the patients who could benefit most from bevacizumab, the optimal bevacizumab treatment duration, and the safety profile of bevacizumab. RESULTS The subset of mbca patients who would benefit the most from the addition of bevacizumab to first-line standard chemotherapy are those with clinically defined aggressive disease. Treatment with bevacizumab should be maintained until disease progression or the appearance of unacceptable toxicity. In the mbca setting, the toxicity profile of bevacizumab is well known and can be managed in clinical practice after adequate training. CONCLUSIONS This expert group recommends administering bevacizumab as first-line treatment in patients with clinically aggressive disease.
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Affiliation(s)
- L Manso
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Moreno
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - R Márquez
- MD Anderson Cancer Center, Madrid, Spain
| | - B Castelo
- Hospital Universitario La Paz, Madrid, Spain
| | - A Arcediano
- Hospital General Universitario de Guadalajara, Guadalajara, Mexico
| | - M Arroyo
- Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | | | - I Calvo
- Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - M J Echarri
- Hospital Universitario Severo Ochoa, Leganés, Spain
| | - S Enrech
- Hospital Universitario de Getafe, Getafe, Spain
| | - A Gómez
- Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | - C Olier
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - P Zamora
- Hospital Universitario La Paz, Madrid, Spain
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Rodrigues-Ferreira S, Nahmias C. G-protein coupled receptors of the renin-angiotensin system: new targets against breast cancer? Front Pharmacol 2015; 6:24. [PMID: 25741281 PMCID: PMC4330676 DOI: 10.3389/fphar.2015.00024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/30/2015] [Indexed: 01/02/2023] Open
Abstract
G-protein coupled receptors (GPCRs) constitute the largest family of membrane receptors, with high potential for drug discovery. These receptors can be activated by a panel of different ligands including ions, hormones, small molecules, and vasoactive peptides. Among those, angiotensins [angiotensin II (AngII) and angiotensin 1–7] are the major biologically active products of the classical and alternative renin-angiotensin system (RAS). These peptides bind and activate three different subtypes of GPCRs, namely AT1, AT2, and Mas receptors, to regulate cardiovascular functions. Over the past decade, the contribution of several RAS components in tumorigenesis has emerged as a novel important concept, AngII being considered as harmful and Ang1–7 as protective against cancer. Development of selective ligands targeting each RAS receptor may provide novel and efficient targeted therapeutic strategies against cancer. In this review, we focus on breast cancer to summarize current knowledge on angiotensin receptors (AT1, AT2, and Mas), and discuss the potential use of angiotensin receptor agonists and antagonists in clinics.
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Affiliation(s)
| | - Clara Nahmias
- Inserm U981, Institut Gustave Roussy Villejuif, France
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8
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Kümler I, Christiansen OG, Nielsen DL. A systematic review of bevacizumab efficacy in breast cancer. Cancer Treat Rev 2014; 40:960-73. [PMID: 24909311 DOI: 10.1016/j.ctrv.2014.05.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED Angiogenesis is a key component of cancer growth, invasion and metastasis. Therefore, inhibition of angiogenesis is an attractive strategy for the treatment of cancer. We systematically describe phase II and III clinical trials of bevacizumab for the treatment of breast cancer. METHODS A computer-based literature search was carried out using PUBMED and conference databases. Original phase II and III studies reporting ≥15 patients who received bevacizumab were included. RESULTS 41 phase II trials were identified in the metastatic setting. Most trials found bevacizumab treatment feasible. Response rates (RR) varied from 0% to 76.5%, time to progression (TTP)/progression free survival (PFS) from 2.4 to 25.3 months and overall survival from 11.5 to more than 38 months. 14 phase III trials including more than 4400 patients with MBC unanimously showed increased RR and PFS, however, no trials demonstrated an OS benefit. In the neoadjuvant setting 23 phase II and III trials were identified. All studies found increased pCR/tpCR but no benefit in terms of OS could be demonstrated. The only study conducted in the adjuvant setting failed to show any survival benefit of bevacizumab. CONCLUSION Despite increased response rates in both the metastatic and neoadjuvant setting, bevacizumab has failed to show any OS benefit. Future trials should include identification of robust predictive biomarkers in order to improve our understanding of molecular biomarkers and mechanisms.
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Affiliation(s)
- Iben Kümler
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
| | - Ole Grummedal Christiansen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
| | - Dorte Lisbet Nielsen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
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Paulmurugan R, Oronsky B, Brouse CF, Reid T, Knox S, Scicinski J. Real time dynamic imaging and current targeted therapies in the war on cancer: a new paradigm. Theranostics 2013; 3:437-47. [PMID: 23781290 PMCID: PMC3677414 DOI: 10.7150/thno.5658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/28/2013] [Indexed: 12/13/2022] Open
Abstract
In biology, as every science student is made to learn, ontology recapitulates phylogeny. In medicine, however, oncology recapitulates polemology, the science of warfare: The medical establishment is transitioning from highly toxic poisons that kill rapidly dividing normal and malignant cells with little specificity to tailored therapies that target the tumors with the lethality of the therapeutic warhead. From the advent of the information age with the incorporation of high-tech intelligence, reconnaissance, and surveillance has resulted in "data fusion" where a wide range of information collected in near real-time can be used to redesign most of the treatment strategies currently used in the clinic. The medical community has begun to transition from the 'black box' of tumor therapy based solely on the clinical response to the 'glass box' of dynamic imaging designed to bring transparency to the clinical battlefield during treatment, thereby informing the therapeutic decision to 'retreat or repeat'. The tumor microenvironment is dynamic, constantly changing in response to therapeutic intervention, and therefore the therapeutic assessment must map to this variable and ever-changing landscape with dynamic and non-static imaging capabilities. The path to personalized medicine will require incorporation and integration of dynamic imaging at the bedside into clinical practice for real-time, interactive assessment of response to targeted therapies. The application of advanced real time imaging techniques along with current molecularly targeted anticancer therapies which alter cellular homeostasis and microenvironment can enhance therapeutic interventions in cancer patients and further improve the current status in clinical management of patients with advanced cancers.
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