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and 1p/19q co-deletion (predictive) are currently routinely used for evaluation of
glioma patients by clinicians in the US and UK. However, the ongoing development
of targeted therapies as mono and combination treatments necessitates the discov-
ery of optimally predictive molecular biomarkers, which will further our under-
standing of these tumors. Additionally, biomarker analysis will become a major
factor in glioma clinical trials, with rapid identifi cation of putative biomarkers in
early stage trials with suffi cient statistical power to validate predictive associations
in phase III trials. Care will therefore be required to distinguish biomarkers that
provide prognostic information from those that have predictive validity. This
approach enable future personalized therapeutic choices with minimal toxicity and
improve clinical outcomes for patients in whom the diagnosis of a malignant glioma
still portends a dismal outlook (Haynes et al. 2014 ).
Personalized Management of Breast Cancer
Personalized management of breast cancer involves improved diagnosis and selec-
tion of therapy as well as development of personalized drugs, which are targeted and
specifi c for cancer pathways involved in breast cancer. Ninety percent of patients
with early-stage breast cancer can be cured when treated only with radiation and
surgery, but another 3 % also require chemotherapy to stop the cancer from spread-
ing elsewhere. The problem is to identify these 3 %. Most patients endure chemo-
therapy and its devastating side effects, even though for 90 % of them the treatment
is unnecessary. Breast cancer was the fi rst cancer where a personalized approach
was identifi ed by making a distinction between estrogen receptor positive and nega-
tive cancers. Breast cancer can be typed into the following categories with distinct
differences in prognosis and response to therapy:
- Estrogen receptor (ER) positive: 65–75 % of breast cancers are ER+ and are
further divided into luminal A and luminal B subtypes. - HER2 positive constitute 15–20 % of breast cancer.
- Basaloid type constitutes 15 % of cases and includes those with BRCA1 and P53
mutations. - Triple negative for ER, progesterone receptors (PR), and HER2 receptors.
Developing Personalized Drugs for Breast Cancer
Developing Drugs Targeted to Pathways Involved in Breast Cancer Up to
75 % of breast cancer patients have an abnormality in a specifi c cell signaling path-
way, drugs that target different molecules along that pathway may be especially
effective for treating the disease. Phosphatidylinositol 3 kinase (PI3K) pathway is
linked to critical growth factor receptors and is involved in programmed cell death,
is aberrant at multiple levels in breast cancer, including mutations in PI3K itself or
10 Personalized Therapy of Cancer