65; p = .01). Similar results were shown for p27/ERCC1. Nevertheless, the prognostic effect decreased over time [70]. The other

analyzed markers had a weaker or null predictive role [71, 72]. JBR-10-[BIO]: K-RAS wt and p-53 wt patients seemed to benefit selleck chemical more from ACT with cisplatinum and vinorelbine (vs mutants) although the interaction test for treatment effect was not significant. P53 expression was prognostic of worse OS in the control arm (HR = 1.89; p = .03), while in the treatment arm it had a positive predictive role (HR = 0.54; p = .02)[73]. From JBR-10 dataset an m-RNA based-15 gene signature was proposed to differentiate high from low risk patients. The HR for death in the observation group was 18 (adjusted at multivariate

analysis; 95% CI 5.12-44.04; p < .001). The prognostic power was validated on 4 separate dataset and by RT-PCR on the original dataset. The positive predictive role was confirmed for high risk group (HR of death 0.33; 95% CI 0.17-0.63; p = .0005) but not for low risk (HR = 3.67; p = .21). The external, prospective validation is awaited to confirm these results [74]. Although unpowered to assess the prognostic or predictive impact of EGFR mutation and copy number, a possible Combretastatin A4 concentration trend toward a positive predictive role of the mutation (and copy number) was proposed in JBR10. LACE BIO (ANITA, JBR10, IALT and CALBG 9633) : High class III beta tubulin (TUBB3) expression maintained the negative

prognostic impact seen in previous analysis (HR for death = 1.3; p = .001). In metastatic setting, high TUBB3 expression caused resistance to tubulin-targeting agents [75]. No effect in adjuvant setting was detected (interaction test p = .20), but only a trend toward a major benefit for high expression [76]. Other analyses were performed to assess the prognostic and predictive value of p-53 and KRAS. While neither P53 IHC expression nor mutation were prognostic for JNJ-26481585 order survival, a trend toward a positive predictive role was seen in wild type patients (significant for squamous cell) Alanine-glyoxylate transaminase [77]. Regarding KRAS, a non significant trend toward a worse OS was seen for mutated patients (significant only for non squamous non adenocarcinoma), with predictive role [78]. Other studies : additional potential biomarkers or classifiers involving different pathways (DNA methylation, mTOR, cytoskeleton protein expression) have been retrospectively evaluated in other studies. Results are promising but should be validated in prospective larger randomized clinical trials [79–82]. The target therapy paradox The biomarker-selection approach, i.e. the treatment assignment according to the expression of featured molecular/classifier signatures (for example ERCC1 and BRCA1 for cisplatinum, RRM for gemcitabine) is the basis of many ongoing clinical trials in order to further optimize and customize ACT (table 1).