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Breast Cancer
Both studies, which are summarised in Table 1, will provide an tumour cells also play an important role. For example, the drug
excellent opportunity to address several issues related to tissue metabolism rate may also affect response to therapy, such as the
handling and shipping, reproducibility, quality control and association between adjuvant tamoxifen benefit and the genetic variants
standardisation of these ‘new’ molecular tools. These trials should of CYP2D6, a cytochrome involved in the metabolism of tamoxifen.
47
then provide level I evidence about the clinical relevance of applying Therefore, the application of the rapidly evolving high-throughput
gene expression predictors to daily breast cancer patient management. techniques for the realisation of genomic, proteomic and metabolomic
profiles holds great promise for increasing our biological understanding
Third, four gene expression predictors, which are summarised in of the disease.
Table 2, are currently available as commercial assays: the
Mammaprint
®
70-gene assay
10
(Agendia Inc.), the OncotypeDX Finally, the ultimate purpose of these different ‘-omic’ approaches should
21-gene Recurrence Score
17
(Genomic Health, Inc.), the AviaraDx
®
not be to neglect the commonly used clinico-pathological markers, but
two-gene H/I Ratio
24
(Aviara) and the MapQuant Dx™ Genomic rather to try to find a way to make predictions more accurate by
Grade
16
(Ipsogen). However, the process of commercialisation is on its integrating different types of information, thus providing oncologists
way for a number of additional multigene predictors (reviewed in with more accurate tools to facilitate treatment decision-making for
reference 46). individual patients. ■
To date, most prognostic and predictive studies have focused on tumour Acknowledgements
characteristics, but it is likely that pharmacogenetics, genetic variability in The author would like to thank the Belgian National Foundation for
the metabolism of therapeutic agents and interactions between host and Cancer Research (FNRS) for its support.
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