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Systems biology approaches are beginning to provide information that will enable a more complete view of how the genomic and epigenetic aberrations in cancer cells can alter the homeostasis of signalling networks within the tumour and surrounding microenvironment, both at the organ and organism level. This Review describes the potential of these systems-based approaches and how they are becoming vital for the development and implementation of effective drug discovery and personalized cancer therapy.
Bilateral mastectomy is used to treat an increased percentage of women with unilateral breast cancer in order to prevent a second primary cancer in the unaffected breast. Although this surgical approach has been proposed to benefit women at high risk of contralateral cancer, the decision to remove the contralateral breast is controversial and requires a careful evaluation on an individual basis. This Review discusses the risk factors for contralateral breast cancer, and the evidence that bilateral mastectomy might in fact reduce breast-cancer associated mortality.
The discovery of miRNAs in body fluids has opened up the possibility of using them as non-invasive biomarkers in cancer detection and as predictors of therapy response in cancer treatment. This Review article considers the latest developments in the use of circulating microRNAs as prognostic and predictive biomarkers and discusses their utility in personalized medicine.
In 2013, studies confirmed that HPV infection of target cells predisposes to cervical (pre)cancer. In developed countries, HPV screening revealed superior protection than cytology screening. In India, visual inspection of the cervix after acetic acid application significantly reduced cervical cancer mortality after 12 years. Improved survival for women with advanced disease was observed after adjuvant bevacizumab.
The year 2013 has brought more options for patients with metastatic colorectal cancer (mCRC) with new ways to combine traditional agents, further refinement of predictive molecular for EGFR inhibitors and a new salvage option. Molecular profiling could identify subgroups to further improve treatment selection.
In 2013, the treatment of several NSCLC subtypes was refined. PROFILE-1007 and LUX-Lung 3 confirmed that targeted therapy was superior to chemotherapy, whereas NCIC BR19 and PointBreak failed to show superiority of adjuvant gefitinib and combined maintenance therapy, respectively. These studies reinforced some practices and discouraged others, underscoring the need for new prospective studies.
In this Review, Jeff Shrager and Marty Tenenbaum describe the latest generation of Precision Oncology, and the different ways to keep refining it. In Precision Oncology 3.0, each treatment event provides the chance to learn from it so that such treatment can be applied to other patients with similar characteristics without facing the difficult economic and structural challenges of a clinical trial.
Novel approaches for cancer therapy take advantage of the modulation of the immune system. Immunotherapy is however associated with a number of adverse effects and clinicians will need to become familiar with recognizing and managing them. In this Review the authors describes the toxicity profiles for various anticancer therapies based on immunomodulatory agents.
