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Review
. 2015 Nov 23;108(4):djv362.
doi: 10.1093/jnci/djv362. Print 2016 Apr.

Treatment Algorithms Based on Tumor Molecular Profiling: The Essence of Precision Medicine Trials

Christophe Le Tourneau  1 , Maud Kamal  1 , Apostolia-Maria Tsimberidou  1 , Philippe Bedard  1 , Gaëlle Pierron  1 , Céline Callens  1 , Etienne Rouleau  1 , Anne Vincent-Salomon  1 , Nicolas Servant  1 , Marie Alt  1 , Roman Rouzier  1 , Xavier Paoletti  1 , Olivier Delattre  1 , Ivan Bièche  1
Affiliations
Review

Treatment Algorithms Based on Tumor Molecular Profiling: The Essence of Precision Medicine Trials

Christophe Le Tourneau et al. J Natl Cancer Inst. .

Abstract

With the advent of high-throughput molecular technologies, several precision medicine (PM) studies are currently ongoing that include molecular screening programs and PM clinical trials. Molecular profiling programs establish the molecular profile of patients' tumors with the aim to guide therapy based on identified molecular alterations. The aim of prospective PM clinical trials is to assess the clinical utility of tumor molecular profiling and to determine whether treatment selection based on molecular alterations produces superior outcomes compared with unselected treatment. These trials use treatment algorithms to assign patients to specific targeted therapies based on tumor molecular alterations. These algorithms should be governed by fixed rules to ensure standardization and reproducibility. Here, we summarize key molecular, biological, and technical criteria that, in our view, should be addressed when establishing treatment algorithms based on tumor molecular profiling for PM trials.

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Figures

Figure 1.
Figure 1.
Major signaling pathways and therapeutic targets in cancer.
Figure 2.
Figure 2.
A) Primary resistance biomarkers of receptor tyrosine kinase (RTK) inhibitors/antibodies. B) Secondary resistance biomarkers of receptor tyrosine kinase (RTK) inhibitors/antibodies.
Figure 3.
Figure 3.
Temporal and spatial heterogeneity and molecular techniques in cancer. A) Aspects of tumor heterogeneity. B) Models for secondary resistance emergence following targeted therapy. C) Molecular techniques used to apprehend tumor heterogeneity.
See this image and copyright information in PMC

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