Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 9/2020

01-09-2020 | Review Article

Genomic profiling in oncology clinical practice

Authors: N. Rodríguez, D. Viñal, J. Rodríguez-Cobos, J. De Castro, G. Domínguez

Published in: Clinical and Translational Oncology | Issue 9/2020

Login to get access

Abstract

The development of high-throughput technologies such as next-generation sequencing for DNA sequencing together with the decrease in their cost has led to the progressive introduction of genomic profiling in our daily practice in oncology. Nowadays, genomic profiling is part of genetic counseling, cancer diagnosis, molecular characterization, and as a biomarker of prognosis and response to treatment. Furthermore, germline or somatic genomic characterization of the tumor may provide new treatment opportunities for patients with cancer. In this review, we will summarize the clinical applications and limitations of genomic profiling in oncology clinical practice, focusing on next-generation sequencing.
Literature
1.
2.
Sabour L, Sabour M, Ghorbian S. Clinical applications of next-generation sequencing in cancer diagnosis. Pathol Oncol Res. 2017;23(2):225–34.PubMed
3.
Rizzo JM, Buck MJ. Key principles and clinical applications of "next-generation" DNA sequencing. Cancer Prev Res (Phila). 2012;5:887.
4.
5.
Bennett CW, Berchem G, Jin KY. Cell-free DNA and next-generation sequencing in the service of personalized medicine for lung cancer. Oncotarget. 2016;7(43):71013–355.PubMedPubMedCentral
6.
Hert DG, Fredlake CP, Barron AE. Advantages and limitations of nextgeneration sequencing technologies: a comparison of electrophoresis and non-electrophoresis methods. Electrophoresis. 2008;29:4618–26.PubMed
7.
Taylor JC, Martin HC, Lise S, et al. Factors influencing success of clinical genome sequencing across a broad spectrum of disorders. Nat Genet. 2015;47:717.PubMedPubMedCentral
8.
9.
Bamshad MJ, Ng SB, Bigham AW, et al. Exome sequencing as a tool for Mendelian disease gene discovery. Nat Rev Genet. 2011;12:745.PubMed
10.
Ngeow J, Eng C. Precision medicine in heritable cancer: when somatic tumour testing and germline mutations meet. NPJ Genom Med. Jan 13;1:15006. doi: 10.1038/npjgenmed.2015.6.
11.
Buys SS, Sandbach JF, Gammon A, et al. A study of over 35,000 women with breast cancer tested with a 25-gene panel of hereditary cancer genes. Cancer 2017.
12.
13.
Robson ME, Bradbury AR, Arun B, et al. American Society of clinical oncology policy statement update: genetic and genomic testing for cancer susceptibility. J Clin Oncol. 2015;33:3660–7.PubMed
14.
15.
Kurian AW, Ward KC, Howlader N, et al. Genetic testing and results in a population-based cohort of breast cancer patients and ovarian cancer patients. J Clin Oncol. 2019;37(15):1305.PubMedPubMedCentral
16.
Walsh T, Lee MK, Casadei S, et al. Detection of inherited mutations for breast and ovarian cancer using genomic capture and massively parallel sequencing. Proc Natl Acad Sci USA. 2010;107:12629–333.PubMedPubMedCentral
17.
18.
Van Marcke C, De Leener A, Berliere M, et al. Routine use of gene panel testing in hereditary breast cancer should be performed with caution. Crit Rev Oncol Hematol. 2016;108:33–9.PubMed
19.
Obeid EI, Hall MJ, Daly MB. Multigene panel testing and breast cancer risk: is it time to scale down? JAMA Oncol 2017
20.
Aaltonen LA, Salovaara R, Kristo P, et al. Incidence of hereditary nonpolyposis colorectal cancer and the feasibility of molecular screening for the disease. N Engl J Med. 1998;338:1481–7.PubMed
21.
22.
23.
Cragun D, Radford C, Dolinsky JS, et al. Panel-based testing for inherited colorectal cancer: a descriptive study of clinical testing performed by a US laboratory. Clin Genet. 2014;86:510–20.PubMedPubMedCentral
24.
25.
26.
Stanislaw C, Xue Y, Wilcox WR. Genetic evaluation and testing for hereditary forms of cancer in the era of next-generation sequencing. Cancer Biol Med. 2016;13(1):55–67.PubMedPubMedCentral
27.
Hall MJ, Forman AD, Pilarski R, Wiesner G, Giri VN. Gene panel testing for inherited cancer risk. J Natl Compr Canc Netw. 2014;12:1339–466.PubMed
28.
Varadhachary GR, Raber MN. Cancer of unknown primary site. N Engl J Med. 2014;371:757–65.PubMed
29.
Hainsworth JD, Greco FA. Gene expression profiling in patients with carcinoma of unknown primary site: from translational research to standard of care. Virchows Arch. 2014;464:393–402.PubMed
30.
Erlander MG, Ma XJ, Kesty NC, et al. Performance and clinical evaluation of the 92-gene real-time PCR assay for tumor classification. J Mol Diagn. 2011;13(5):493–503.PubMedPubMedCentral
31.
Pillai R, Deeter R, Rigl CT, et al. Validation and reproducibility of a microarray-based gene expression test for tumor identification in formalin-fixed, paraffin-embedded specimens. J Mol Diagn. 2011;13(1):48–56.PubMedPubMedCentral
32.
Meiri E, Mueller WC, Rosenwald S, et al. nA second-generation microRNA-based assay for diagnosing tumor tissue origin. Oncologist. 2012;17(6):801–12.PubMedPubMedCentral
33.
Hainsworth JD, Rubin MS, Spigel DR, et al. Molecular gene expression profiling to predict the tissue of origin and direct site-specific therapy in patients with carcinoma of unknown primary site: a prospective trial of the Sarah Cannon research institute. J Clin Oncol. 2013;31(2):217.PubMed
34.
Moran S, Martínez-Cardús A, Sayols S, et al. Epigenetic profiling to classify cancer of unknown primary: a multicentre, retrospective analysis. Lancet Oncol. 2016;17(10):1386–95.PubMed
35.
36.
Pob A. Epigenetic profiling of CUP. Cancer Discov. 2016;6(11):1203.
37.
Binder C, Matthes KL, Korol D, et al. Cancer of unknown primary-epidemiological trends and relevance of comprehensive genomic profiling. Cancer Med. 2018;7(9):4814–24.PubMedPubMedCentral
38.
Tothill RW, Li J, Mileshkin L, et al. Massively-parallel sequencing assists the diagnosis and guided treatment of cancers of unknown primary. J Pathol. 2013;231:413–23.PubMed
39.
Ross JS, Wang K, Gay L, et al. Comprehensive genomic profiling of carcinoma of unknown primary site: new routes to targeted therapies. JAMA Oncol. 2015;1:40–9.PubMed
40.
Gatalica Z, Millis SZ, Vranic S, et al. Comprehensive tumor profiling identifies numerous biomarkers of drug response in cancers of unknown primary site: analysis of 1806 cases. Oncotarget. 2014;5:12440–7.PubMedPubMedCentral
41.
Kato S, Krishnamurthy N, Banks KC, et al. Utility of genomic analysis in circulating tumor DNA from patients with carcinoma of unknown primary. Cancer Res. 2017;77:4238–46.PubMedPubMedCentral
42.
Varghese AM, Arora A, Capanu M, et al. Clinical and molecular characterization of patients with cancer of unknown primary in the modern era. Ann Oncol. 2017;28:3015–21.PubMedPubMedCentral
43.
44.
Cardoso F, Kyriakides S, Ohno S, F et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †
45.
Harris LN, Ismaila N, McShane LM, Andre F, et al. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: american society of clinical oncology clinical practice guideline. J Clin Oncol. 2016;34(10):1134.PubMedPubMedCentral
46.
47.
Paik S, Shak S, Tang G, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 2004;351(27):2817.PubMed
48.
Paik S, Tang G, Shak S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24(23):3726.PubMed
49.
Mamounas EP, Tang G, Fisher B, et al. Association between the 21-gene recurrence score assay and risk of locoregional recurrence in node-negative, estrogen receptor-positive breast cancer: results from NSABP B-14 and NSABP B-20. J Clin Oncol. 2010;28(10):1677.PubMedPubMedCentral
50.
Dowsett M, Cuzick J, Wale A, et al. Prediction of risk of distant recurrence using the 21-gene recurrence score in node-negative and node-positive postmenopausal patients with breast cancer treated with anastrozole or tamoxifen: a TransATAC study. J Clin Oncol. 2010;28(11):1829.PubMed
51.
Sparano JA, Gray RJ, Makower DF, et al. Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 2015;373(21):2005.PubMedPubMedCentral
52.
53.
Filipits M, Rudas M, Jakesz R, et al. A new molecular predictor of distant recurrence in ER-positive, HER2-negative breast cancer adds independent information to conventional clinical risk factors. Clin Cancer Res. 2011;17(18):6012–20.PubMed
54.
55.
Dubsky P, Brase JC, Jakesz R, et al. The EndoPredict score provides prognostic information on late distant metastases in ER+/HER2− breast cancer patients. Br J Cancer. 2013;109(12):2959–64.PubMedPubMedCentral
56.
Müller BM, Brase JC, Haufe F, et, al. Comparison of the RNA-based EndoPredict multigene test between core biopsies and corresponding surgical breast cancer sections. J Clin Pathol. 2012;65(7):660–2.
57.
Jerevall PL, Ma XJ, Li H, Salunga R, Kesty NC, Erlander MG, et al. Prognostic utility of HOXB13: IL17BR and molecular grade index in early-stage breast cancer patients from the Stockholm trial. Br J Cancer. 2011;104:1762–9.PubMedPubMedCentral
58.
Jankowitz RC, Cooper K, Erlander M, Ma XJ, Kesty NC, Li H, et al. Prognostic utility of the breast cancer index and comparison to adjuvant! Online in a clinical case series of early breast cancer. Breast Cancer Res. 2011;13:R98.PubMedPubMedCentral
59.
Ma XJ, Wang Z, Ryan PD, et al. A two-gene expression ratio predicts clinical outcome in breast cancer patients treated with tamoxifen. Cancer Cell. 2004;5(6):607.PubMed
60.
Sgroi DC, Carney E, Zarrella E, et al. Prediction of late disease recurrence and extended adjuvant letrozole benefit by the HOXB13/IL17BR biomarker. J Natl Cancer Inst. 2013;105:1036.PubMedPubMedCentral
61.
Jansen MP, Sieuwerts AM, Look MP, et al. HOXB13-to-IL17BR expression ratio is related with tumor aggressiveness and response to tamoxifen of recurrent breast cancer: a retrospective study. J Clin Oncol. 2007;25:662.PubMed
62.
Sgroi DC, Sestak I, Cuzick J, et al. Prediction of late distant recurrence in patients with oestrogen-receptor-positive breast cancer: a prospective comparison of the breast-cancer index (BCI) assay, 21-gene recurrence score, and IHC4 in the TransATAC study population. Lancet Oncol. 2013;14:1067.PubMedPubMedCentral
63.
Sgroi DC, Carney E, Zarrella E, et al. Prediction of late disease recurrence and extended adjuvant letrozole benefit by the HOXB13/IL17BR biomarker. J Natl Cancer Inst. 2013;105(14):1036.PubMedPubMedCentral
64.
Dowsett M, Sestak I, Lopez-Knowles E, et al. Comparison of PAM50 risk of recurrence score with oncotype DX and IHC4 for predicting risk of distant recurrence after endocrine therapy. J Clin Oncol. 2013;31(22):2783.PubMed
65.
Gnant M, Filipits M, Greil R, et al. Predicting distant recurrence in receptor-positive breast cancer patients with limited clinicopathological risk: using the PAM50 risk of recurrence score in 1478 postmenopausal patients of the ABCSG-8 trial treated with adjuvant endocrine therapy alone. Ann Oncol. 2014;25(2):339–45.PubMed
66.
Perez EA, Ballman KV, Mashadi-Hossein A, et al. Intrinsic subtype and therapeutic response among HER2-positive breast tumors from the NCCTG (Alliance) N9831 trial. J Natl Cancer Inst. 2017;109(2):1.
67.
Parker JS, Mullins M, Cheang MC, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol. 2009;27(8):1160.PubMedPubMedCentral
68.
Van de Vijver MJ, He YD, van’t Veer LJ, et al. A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med. 2002;347:1999–2009.PubMed
69.
Vant Veer LJ, Dai H, van de Vijver MJ, et al. Gene expression profiling predicts clinical outcome of breast cancer. Nature. 2002;415(6871):530.
70.
Cardoso F, vant Veer LJ, Bogaerts J, et al. 70-gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016;375(8):717.
71.
O'Connell MJ, Lavery I, Yothers G, et al. Relationship between tumor gene expression and recurrence in four independent studies of patients with stage II/III colon cancer treated with surgery alone or surgery plus adjuvant fluorouracil plus leucovorin. J Clin Oncol. 2010;28:3937–44.PubMedPubMedCentral
72.
Gray RG, Quirke P, Handley K, et al. Validation study of a quantitative multigene reverse transcriptase-polymerase chain reaction assay for assessment of recurrence risk in patients with stage II colon cancer. J Clin Oncol. 2011;29:4611–9.PubMed
73.
Venook AP, Niedzwiecki D, Lopatin M, et al. Biologic determinants of tumor recurrence in stage II colon cancer: validation study of the 12-gene recurrence score in cancer and leukemia group B (CALGB) 9581. J Clin Oncol. 2013;31:1775–811.PubMedPubMedCentral
74.
Salazar R, Roepman P, Capella G, et al. Gene expression signature to improve prognosis prediction of stage II and III colorectal cancer. J Clin Oncol. 2011;29:17–24.PubMed
75.
Kopetz S, Tabernero J, Rosenberg R, et al. Genomic classifier ColoPrint predicts recurrence in stage II colorectal cancer patients more accurately than clinical factors. Oncologist. 2015;20:127–33.PubMedPubMedCentral
76.
Kennedy RD, Bylesjo M, Kerr P, et al. Development and independent validation of a prognostic assay for stage II colon cancer using formalin-fixed paraffin-embedded tissue. J Clin Oncol. 2011;29:4620–6.PubMed
77.
Niedzwiecki D, Frankel WL, Venook AP, et al. Association between results of a gene expression signature assay and recurrence-free interval in patients with stage II colon cancer in cancer and leukemia group B 9581 (Alliance). J Clin Oncol. 2016;34:3047–53.PubMedPubMedCentral
78.
79.
Drilon A, Wang L, Arcila ME, et al. Broad, hybrid capture-based next-generation sequencing identifies actionable genomic alterations in lung adenocarcinomas otherwise negative for such alterations by other genomic testing approaches. Clin Cancer Res. 2015;21:3631–9.PubMedPubMedCentral
80.
Su J, Zhang XC, An SJ, et al. Detecting the spectrum of multigene mutations in non-small cell lung cancer by Snapshot assay. Chin J Cancer. 2014;33:346–50.PubMedPubMedCentral
81.
Han JY, Kim SH, Lee YS, et al. Comparison of targeted next generation sequencing with conventional sequencing for predicting the responsiveness to epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy in never-smokers with lung adenocarcinoma. Lung Cancer. 2014;85:161–7.PubMed
82.
Tuononen K, Maki-Nevala S, Sarhadi VK, et al. Comparison of targeted next-generation sequencing (NGS) and real-time PCR in the detection of EGFR, KRAS, and BRAF mutations on formalin-fixed, paraffinembedded tumor material of non-small cell lung carcinomadsuperiority of NGS. Genes Chromosomes Cancer. 2013;52:503–11.PubMed
83.
Scarpa A, Sikora K, Fassan M, et al. Molecular typing of lung adenocarcinoma on cytological samples using a multigene next generation sequencing panel. PLoS ONE. 2013;8:e80478.PubMedPubMedCentral
84.
Lindeman NI, Cagle PT, Aisner DL, et al. Updated molecular testing guideline for the selection of lung cancer patients for treatment with targeted tyrosine kinase inhibitors: guideline from the college of american pathologists, the international association for the study of lung cancer, and the association for molecular pathology. J Mol Diagn. 2018;20(2):129–59. https://​doi.​org/​10.​1016/​j.​jmoldx.​2017.​11.​004(Epub 2018 Jan 23).CrossRefPubMed
85.
Sepulveda AR, Hamilton SR, Allegra CJ, et al. Molecular biomarkers for the evaluation of colorectal cancer: guideline from the american society for clinical pathology, college of American pathologists, association for molecular pathology, and the American Society of Clinical Oncology. J Clin Oncol. 2017;35(13):1453–86.PubMed
86.
Mulero-Sánchez A, Pogacar Z, Vecchione L. Importance of genetic screens in precision oncology. ESMO Open. 2019;4(3):e000505.PubMedPubMedCentral
87.
Woodcock J, LaVange LM. Master protocols to study multiple therapies, multiple diseases, or both. N Engl J Med. 2017;377(1):62–70.PubMed
88.
Gray SW, Hicks-Courant K, Lathan CS, et al. Attitudes of patients with cancer about personalized medicine and somatic genetic testing. J Oncol Pract. 2012;8:329–35.PubMedPubMedCentral
89.
Gray SW, Hicks-Courant K, Cronin A, et al. Physicians’ attitudes about multiplex tumor genomic testing. J Clin Oncol. 2014;32:1317–23.PubMedPubMedCentral
90.
Zehir A, Benayed R, Shah RH, et al. Mutational landscape of metastatic cancer revealed from prospective clinical sequencing of 10,000 patients. Nat Med. 2017;23:703.PubMedPubMedCentral
91.
Allegretti M, Fabi A, Buglioni S, et al. Tearing down the walls: FDA approves next generation sequencing (NGS) assays for actionable cancer genomic aberrations J Exp Clin Cancer Res. 2018;37:47.
92.
Cheng ML, Berger MF, Hyman DM, Solit DB. Clinical tumour sequencing for precision oncology: time for a universal strategy. Nat Rev Cancer. 2018;18:527–8.PubMedPubMedCentral
93.
Zimmer K, Kocher F, Spizzo G. Treatment according to molecular profiling in relapsed/refractory cancer patients: a review focusing on latest profiling studies. Comput Struct Biotechnol J. 2019;17:447–53.PubMedPubMedCentral
94.
95.
96.
Buzyn A, Blay J-Y, Hoog-Labouret N, et al. Equal access to innovative therapies and precision cancer care. Nat Rev Clin Oncol. 2016;13:385–93.PubMed
97.
98.
99.
Group E-ACR, Others. Executive summary: interim analysis of the NCI-MATCH trial. ECOG-ACRIN Cancer Research Group.
100.
Meric-Bernstam F, Brusco L, Shaw K, et al. Feasibility of large-scale genomic testing to facilitate enrollment onto genomically matchedclinical trials. JCO. 2015;33:2753–62.
101.
Chan TA, Yarchoan M, Jaffee E, et al. Development of tumor mutation burden as an immunotherapy biomarker: utility for the oncology clinic. Ann Oncol. 2019;30(1):44–56.PubMed
102.
Gandara DR, Paul SM, Kowanetz M, et al. Blood-based tumor mutational burden as a predictor of clinical benefit in non-small-cell lung cancer patients treated with atezolizumab. Nat Med. 2018;24(9):1441–8.PubMed
103.
Hellmann MD, Ciuleanu TE, Pluzanski A, et al. Nivolumab plus ipilimumab in lung cancer with a high tumor mutational burden. N Engl J Med. 2018;378(22):2093–104.PubMedPubMedCentral
104.
105.
Clonal neoantigens elicit T cell immunoreactivity and sensitivity to immune checkpoint blockade. Science 2016;351(6280): 1463–1469.
106.
Alexandrov LB, Nik-Zainal S, Wedge DC, et al. Signatures of mutational processes in human cancer. Nature. 2013;500(7463):415–21.PubMedPubMedCentral
107.
108.
Wallbillich JJ, Forde B, Havrilesky LJ, Cohn DE. A personalized para-digm in the treatment of platinum-resistant ovarian cancer—a costutility analysis of genomic-based versus cytotoxic therapy. GynecolOncol. 2016;142:144–9.
109.
Li Y, Bare LA, Bender RA, et al. Cost effectiveness of sequencing34 cancer-associated genes as an aid for treatment selection inpatients with metastatic melanoma. Mol Diagn Ther. 2015;19:169–77.PubMedPubMedCentral
110.
Doble B, John T, Thomas D, et al. Cost-effectiveness of precisionmedicine in the fourth-line treatment of metastatic lung adenocarci-noma: an early decision analytic model of multiplex targeted sequenc-ing. Lung Cancer. 2016;107:22–35.PubMed
111.
Gallego CJ, Shirts BH, Bennette CS, et al. Next-generation sequenc-ing panels for the diagnosis of colorectal cancer and polyposis syn-dromes: a cost-effectiveness analysis. J Clin Oncol. 2015;33:2084–91.PubMedPubMedCentral
112.
Bennette CS, Gallego CJ, Burke W, Jarvik GP, Veenstra DL. The cost-effectiveness of returning incidental findings from next-generation genomic sequencing. Genet Med. 2015;17:587–95.PubMed
113.
Li Y, Arellano AR, Bare LA, Bender RA, Strom CM, Devlin JJ. A multi-gene test could cost-effectively help extend life expectancy forwomen at risk of hereditary breast cancer. Value Health. 2017;20:547–55.PubMed
114.
Yu TM, Morrison C, Gold EJ, et al. Budget impact of next-generation sequencing for molecular assessment of advanced non-small cell lung cancer. Value Health. 2018;21(11):1278–85.PubMed
115.
Hall PS, Smith A, Hulme C, et al. Value of information analysis of multiparameter tests for chemotherapy in early breast cancer: the OPTIMA prelim trial. Value Health. 2017;20:1311–8.PubMed
Metadata
Title
Genomic profiling in oncology clinical practice
Authors
N. Rodríguez
D. Viñal
J. Rodríguez-Cobos
J. De Castro
G. Domínguez
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 9/2020
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-020-02296-9

Other articles of this Issue 9/2020

Clinical and Translational Oncology 9/2020 Go to the issue

Research Article

Eastern Spanish experience with nivolumab in metastatic renal cell carcinoma

Research Article

The effect of metformin on gastric cancer in patients with type 2 diabetes: a systematic review and meta-analysis

Research Article

DT-13 inhibits breast cancer cell migration via non-muscle myosin II-A regulation in tumor microenvironment synchronized adaptations

Research Article

A new scenario in metastatic renal cell carcinoma: a SOG-GU consensus

Brief Research Article

Immunotherapy-based combinations versus standard first-line treatment for metastatic clear cell renal cell carcinoma: a systematic review and meta-analysis

Research Article

Treatment patterns for metastatic colorectal cancer in Spain
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits