From: Evaluation of the current knowledge limitations in breast cancer research: a gap analysis
What do we know? | The selective use of combinations of surgery, radiotherapy, chemotherapy, and biological therapies has improved patient survival in recent years. |
 | Not all therapies used are effective on all patients. |
What are the gaps? | There is an incomplete understanding of the biology of breast cancer including the effects of compensatory signalling pathways responsible for drug resistance. |
 | We cannot determine who goes on to develop metastatic disease or drug-resistant cancers. |
 | Individualisation of therapies could be improved. |
 | The optimal duration of therapy is unclear for many drugs. |
Problems | There are insufficient model systems for the complexity and diversity of breast cancer. |
 | The need to understand not only the cancer, but the tumour microenvironment and patient characteristics (including drug metabolism and immune mechanisms). |
 | Availability of clinical material is scarce, particularly from metastatic disease tissues. |
 | The neoadjuvant model could be used more effectively. |
Translational implications | Patients could be selected for appropriate therapy more effectively. |
 | Enhanced understanding of the sequencing, combinations and duration of treatments. |
Recommendations | Build resources through high-quality, uniform, multicentre collection of clinical material from breast cancer patients before and during treatment (including neoadjuvant studies), including samples of primary tumours as well as metastatic deposits. |
 | Develop methods for easy, reproducible monitoring of response to and development of resistance to therapy, as well as early disease progression. |
 | Increase research efforts into the role of the tumour microenvironment and the immune system in the development and treatment of breast cancer. |