A Personalized Approach to Cancer Treatment: How Biomarkers Can Help

Abstract

Background: The present approach to cancer treatment is often referred to as “trial and error” or “one size fits all.” This practice is inefficient and frequently results in inappropriate therapy and treatment-related toxicity. In contrast, personalized treatment has the potential to increase efficacy and decrease toxicity. Content: We reviewed the literature relevant to prognostic, predictive, and toxicity-related markers in cancer, with particular attention to systematic reviews, prospective randomized trials, and guidelines issued by expert panels. To achieve personalized treatment for cancer, we need markers for determining prognosis, predicting response to therapy, and predicting severe toxicity related to treatment. Among the best-validated prognostic markers currently available are serum concentrations of α-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) for patients with nonseminoma germ cell tumors and tissue concentrations of both urokinase plasminogen activator and plasminogen activator inhibitor 1 (PAI-1) for breast cancer patients. Clinically useful therapy predictive markers are estrogen and progesterone receptors to select patients with breast cancer for treatment with endocrine therapy and human epidermal growth factor receptor 2 (HER-2) to select breast cancer patients for treatment with trastuzumab (Herceptin). Markers available for identifying drug-induced adverse reactions include thiopurine methyltransferase (TPMT) to predict toxicity from thiopurines in the treatment of acute lymphoblastic leukemia and uridine diphosphate glucuronyltransferase to predict toxicity from irinotecan in the treatment of colorectal cancer. Conclusions: Validated prognostic, predictive, and toxicity markers should help cancer treatment move from the current trial-and-error approach to more personalized treatment.

Methylated genes as new cancer biomarkers

“…Finally, with the approaching era of personalised medicine, the link between biomarkers and therapy will be enhanced. 113,114 In this context, it should be stated that a number of therapies directed against methylated genes are now in clinical use. 8 Thus, the hypomethylating agents 5-azacytidine and 5 0 aza-2 0 deoxycytidine have been approved for the treatment of specific leukaemia and the myelodysplastic syndrome.…”

Salivary analysis of oral cancer biomarkers

“…CycD1 and Ki67 are cell-cycle regulators, which have been shown to be correlated with cellular proliferation and tumour progression, metastasis and poor prognosis (Liu et al, 2003;Adjei, 2005;Wang et al, 2006) and accordingly are expected to increase in tumours. LDH was found to increase in the serum of various malignancies and has been identified as the main recurrent adverse prognostic factors (Schneider, 2006;Duffy and Crown, 2008;Culine, 2009). As for the demonstrated increase in MMP-9, it is worth noting that it was shown earlier to be elevated in saliva and that strong stromal MMP-9-staining intensity was correlated with poor tumour differentiation (Kosunen et al, 2007).…”

Biomarkers in Gastrointestinal Cancer: Focus on Colon, Pancreatic and Gastric Cancer

“…Although hundreds of these markers have been proposed in the last 2 to 3 decades, the current reality is that no molecular marker, other than the KRAS gene in the case of epidermal growth factor receptor (EGFR)-targeted therapy for metastatic disease, has made it into clinical practice (Duffy & Crown, 2008) ).…”