Imaging Biomarkers for Precision Medicine in Locally Advanced Breast Cancer

Guidelines from the American National Comprehensive Cancer Network (NCCN)recommend neoadjuvant chemotherapy (NAC) to patients with locally advanced breast cancer (LABC) to downstage tumors before surgery. However, only a small fraction (15-17%) of LABC patients achieve complete pathologic response (pCR), i.e. no residual tumor in the breast, after treatment. Measuring tumor response during 53 neoadjuvant chemotherapy can potentially help physicians adapt treatment thus, potentially improving the pCR rate. Recently, imaging biomarkers that are used to measure the tumor’s functional and biological features have been studied as pre-treatment markers for pCR or as an indicator for intra-treatment tumor response. Also, imaging biomarkers have been the focus of intense research to characterize tumor heterogeneity as well as to advance our understanding of the principle mechanisms behind chemoresistance. Advances in investigational radiology are moving rapidly to high-resolution imaging, capturing metabolic data, performing tissue characterization and statistical modelling of imaging biomarkers, with an endpoint of personalized medicine in breast cancer treatment. In this commentary, we present studies within the framework of imaging biomarkers used to measure breast tumor response to chemotherapy. Current studies are showing that significant progress has been made in the accuracy of measuring tumor response either before or during chemotherapy, yet the challenges at the forefront of these works include translational gaps such as needing large-scale clinical trials for validation, and standardization of imaging methods. However, the ongoing research is showing that imaging biomarkers may play an important role in personalized treatments for LABC.