Correlating and Combining Genomic and Proteomic Assessment with In Vivo Molecular Functional Imaging: Will This Be the Future Roadmap for Personalized Cancer Management?

Recently, there has been an increasing interest in personalized approach in cancer management. Two developments could be regarded important for realization of this concept: (1) new biomarkers and (2) in vivo molecular tracers for both positron emission tomography and single photon emission computed tomography. Both approaches are successful in exploring tumor biology individually and can serve as tools to better stratify tumors for potential personalized medicine. The fundamental concept comes from the observation that one treatment does not work for all patients, even those with similar histopathology, essentially because of varying tumor genotype and phenotypic behavior pattern in each individual. Clinically validated biomarkers and tracers allow physicians to determine which patient may benefit from a particular therapy. Despite progress in the past decade, the concept is still in the early stages of clinical translation. In this review, the authors hypothesize the feasibility of integration of these two powerful techniques, which could lead to a faster translation and provide a more reliable basis toward the personalized approach in oncology. The authors believe that clinically validated biomarkers and tracers would allow physicians to determine which patients may benefit from personalized therapy. The logistics and implications of this combined approach for the day-to-day clinical oncology practice are discussed with special emphasis on neuroendocrine tumors, which demonstrates widely variable tumor biology. A logical way is also illustrated to explain how biomarkers and in vivo tracers could be complemented in a clinical workflow.