Biomarkers are potentially useful in cancer detection (screening and aiding diganosis), asssessing prognosis, upfront predicting likely response or resistance to therapy and monitoring ongoing therapy [for review, see ref. 52].
Sometimes, in daily clinical practice, patients treated with upfront chemotherapy experienced minimal response with stable disease or partial response with tumor reduction among 30% in volume and are candidates for palliative chemoradiation or second line Erlotinib.
Patients who are "no responders" to upfront chemotherapy, achieved an objective response rate of 53.3% after chemoradiation and TKIs combination with "complete response" in 13.3% of cases.
Upfront combination FOLFOX significantly improved response rate and PFS, but no improvement of OS was seen over sequential treatment (Cunningham et al, 2009).
Currently, there are no reliable, noninvasive biologic markers to detect the presence or progression of disease, assess therapy response, or provide upfront prognostic insights.
Efficient treatment tailoring can improve the allocation of health care resources by identifying upfront the probability of patient response to a particular treatment and identifying subgroups of patients in need of other medical approaches.
Receiver operating curve (ROC) analysis was used to assess the sensitivity and specificity of high AUC (>50th percentile) as a parameter of ex vivo Pt- GpG) Pt- GpGence to persistenceponse from patoents upredictto cytotoxic theresponse revealed a sensitivity ofrom% and a spatientsty of 83% with a significance of P=0.01 and an ROC area upfronthe curve of 0.817.
There are other potential advantages of this upfront approach despite the lack of primary response rates.
Hence, even large upfront investments in defining targets linked to response in early trials could prove highly cost-effective.
The key to the success of escalation therapy is to define upfront with the patient the exact suboptimal response threshold at which the next-level therapeutic option should be introduced.
