Incorporating Molecular Oncology into Prognosis

Abstract

AbstractIn this chapter, we examine recent advances in major categories of molecular prognostic factors, address problems with integrating them into clinical practice, and describe possible remedies to the current situation. Molecular prognostic factors can be categorized based on their involvement in specific biological pathways. Molecular prognostic factors research comprises the triadic intersection of outcome research, biomarker research, and molecular biology. We will also focus on how the technological advances in the postgenomics era can be integrated into clinical practice. Molecular cancer prognostic factors interface with clinical practice in a wide variety of ways, through the use of molecular variables to identify high‐risk individuals, to detect disease in its early stages, to discover novel drugs (by identifying targets and pathways), to individualize therapy (pharmacogenomics), and to monitor patients. Effects of methylation on cancer prognosis and staging are being explored currently. Gene copy number may be one area that is ripe for integration into staging schema in the coming years. DNA repair may play dual roles in cancer prognosis. We are on the brink of the integration of molecular prognostic factors into practice. Bioinformatics will form one cornerstone of this process, as huge amounts of molecular information become available per sample. Regulatory approval is needed in order to use molecular prognostic factors in the clinical setting, a necessary and parallel step to incorporation into prognostic systems. The use of microarray technology opens new perspectives and brings the simultaneous identification of numerous DNA alterations at a grip, while microarrays or proteomic technologies help us to read the molecular signature (thousands of genes and proteins) of an individual patient's tumor. This is the promise of the future that eagerly awaits us.