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Molecular biomarkers in gastro-esophageal cancer: recent developments, current trends and future directions

Authors
  • Battaglin, Francesca1, 2
  • Naseem, Madiha1
  • Puccini, Alberto1, 3
  • Lenz, Heinz-Josef1
  • 1 University of Southern California, Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, 1441 Eastlake Avenue, Suite 5410, Los Angeles, CA, 90033, USA , Los Angeles (United States)
  • 2 Veneto Institute of Oncology IOV-IRCCS, Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Padua, 35128, Italy , Padua (Italy)
  • 3 Ospedale Policlinico San Martino, Oncologia Medica 1, Genoa, 16132, Italy , Genoa (Italy)
Type
Published Article
Journal
Cancer Cell International
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jul 11, 2018
Volume
18
Issue
1
Identifiers
DOI: 10.1186/s12935-018-0594-z
Source
Springer Nature
Keywords
License
Green

Abstract

Gastro-esophageal adenocarcinomas (GEA) represent a severe global health burden and despite improvements in the multimodality treatment of these malignancies the prognosis of patients remains poor. HER2 overexpression/amplification has been the first predictive biomarker approved in clinical practice to guide patient selection for targeted treatment with trastuzumab in advanced gastric and gastro-esophageal junction cancers. More recently, immunotherapy has been approved for the treatment of GEA and PD-L1 expression is now a biomarker required for the administration of pembrolizumab in these diseases. Significant progress has been made in recent years in dissecting the genomic makeup of GEA in order to identify distinct molecular subtypes linked to distinct patterns of molecular alterations. GEA have been found to be highly heterogeneous malignances, representing a challenge for biomarkers discovery and targeted treatment development. The current review focuses on an overview of established and novel promising biomarkers in GEA, covering recent molecular classifications from TCGA and ACRG. Main elements of molecular heterogeneity are discussed, as well as emerging mechanisms of primary and secondary resistance to HER2 targeted treatment and recent biomarker-driven trials. Future perspectives on the role of epigenetics, miRNA/lncRNA and liquid biopsy, and patient-derived xenograft models as a new platform for molecular-targeted drug discovery in GEA are presented. Our knowledge on the genomic landscape of GEA continues to evolve, uncovering the high heterogeneity and deep complexity of these tumors. The availability of new technologies and the identification of promising novel biomarker will be critical to optimize targeted treatment development in a setting where therapeutic options are currently lacking. Nevertheless, clinical validation of novel biomarkers and treatment strategies still represents an issue.

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