title: New approaches for improving outcomes in breast cancer in Europe.
abstract: Considerable progress has been made in breast cancer treatment in Europe over the past three decades, yet survival rates for metastatic disease remain poor, underlining the need for further advances. While the use of predictive biomarkers for response to systemic therapy could improve drug development efficiency, progress in identifying such markers has been slow. The currently inadequate classification of breast cancer subtypes is a further challenge. Improved understanding of the molecular pathology of the disease has led to the identification of new targets for drug treatment, and evolving classifications should reflect these developments. Further ongoing challenges include difficulties in finding optimal combinations and sequences of systemic therapies, circumventing multidrug resistance and intra-tumor heterogeneity, problems associated with fragmentation in clinical trials and translational research efforts. Adoption of some of the strategies identified in this article may lead to further improvements in outcomes for patients with the disease.
authors.affiliation: Sandro Pitigliani Department of Medical Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy. Electronic address: adileo@usl4.toscana.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Leo
authors.affiliation: European Institute of Oncology, Division of Medical Oncology, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curigliano
authors.affiliation: Department of Clinical Research, Institut Curie, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Diéras
authors.affiliation: Sandro Pitigliani Department of Medical Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Malorni
authors.affiliation: Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Christos
authors.initials: C
authors.lastname: Sotiriou
authors.affiliation: Cancer Research UK, London Research Institute, London, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Swanton
authors.affiliation: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Alastair
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Breakthrough Breast Cancer Research Centre, Institute of Cancer Research and Kings College London School of Medicine, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tutt
authors.affiliation: Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Piccart
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D054316:Biomarkers, Pharmacological; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000401:mortality; D019008:Drug Resistance, Neoplasm; D005060:Europe; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy; D017063:Outcome Assessment, Health Care
chemical_list: D000970:Antineoplastic Agents; D054316:Biomarkers, Pharmacological; D014408:Biomarkers, Tumor
keywords: Biomarker; Breast cancer; Classification; Pathogenesis; Resistance; Treatment