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Journal for Research in Applied Sciences ISSN: 2583-4053

and Biotechnology Volume-2 Issue-6 || December 2023 || PP. 175-183


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Targeted Therapies in Cancer Treatment: Unveiling the Latest


Breakthroughs and Promising Approaches
Vishal Rai1, Yash Gupta2, Shobhit Prakash Srivastava3, Amrita Shukla4, Nisha Bano5 and Soban Khan6
1,2,3,4,5,6
Department of Pharmacy, Dr. M.C. Saxena College of Pharmacy, Uttar Pradesh, INDIA.
1
Corresponding Author: [email protected]

www.jrasb.com || Vol. 2 No. 6 (2023): December Issue

Received: 29-12-2023 Revised: 01-01-2024 Accepted: 05-01-2024

ABSTRACT

This review article delves into the realm of cancer treatment, specifically focusing on targeted therapies. It aims to present
the most recent breakthroughs and promising approaches in this rapidly evolving field. Targeted therapies have emerged as a
revolutionary approach in cancer treatment, aiming to selectively and precisely attack cancer cells while sparing normal tissues.
This article explores various targeted therapy strategies, including monoclonal antibodies, small molecule inhibitors,
immunotherapies, and gene therapies. In recent years, there have been significant advancements in understanding the molecular
and genetic basis of cancer, which has led to the identification of novel therapeutic targets. The article sheds light on these newly
discovered targets and highlights their potential in designing more effective and personalized treatment regimens for cancer
patients. Furthermore, the review addresses the challenges and limitations associated with targeted therapies, such as resistance
mechanisms and the heterogeneity of tumors. Strategies to overcome these obstacles are discussed, including combination
therapies and the development of next-generation targeted agents. The role of precision medicine in cancer treatment is also
explored, emphasizing the importance of biomarker-guided therapy selection to optimize treatment outcomes. Additionally, the
review touches upon the integration of targeted therapies with conventional treatments, such as chemotherapy and radiation
therapy, to enhance overall treatment efficacy. Finally, the article examines ongoing clinical trials and preclinical studies that are
investigating cutting-edge targeted therapies, showcasing the potential impact of these approaches in transforming cancer care.
In conclusion, targeted therapies in cancer treatment represent a rapidly expanding field with remarkable breakthroughs
and promising avenues. Understanding the latest advancements and challenges in this domain is essential to harness the full
potential of targeted therapies and ultimately improve patient outcomes in the battle against cancer.

Keywords- Cancer prevention, Anticancer.

I. INTRODUCTION present on cancer cells. Unlike traditional treatments,


which indiscriminately attack rapidly dividing cells,
Cancer remains a formidable health challenge, targeted therapies are designed to home in on unique
affecting millions of lives worldwide. Over the years, features of cancer cells. This precision allows for a more
considerable progress has been made in the realm of effective attack on cancer while minimizing damage to
cancer treatment, leading to improved outcomes. healthy cells, reducing adverse effects for patients.
However, conventional therapies like chemotherapy and These therapies work by interfering with specific
radiation have limitations in terms of efficacy and molecules or pathways that play crucial roles in cancer
potential side effects. In recent times, targeted therapies cell growth and survival. By doing so, targeted therapies
have emerged as a promising frontier in cancer treatment, aim to halt or slow down the progression of cancer,
revolutionizing the way we approach the disease.[1] potentially leading to better treatment outcomes.
Overview of Targeted Therapies in Cancer Treatment: Furthermore, targeted therapies can be tailored to the
Targeted therapies represent a novel approach to genetic makeup of an individual's tumor, making them an
cancer treatment, focusing on specific molecular targets essential component of precision medicine.[2]

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Importance of Targeted Approaches in Precision II. MOLECULAR BASIS OF


Medicine: TARGETED THERAPIES
Precision medicine is a patient-centered
approach that takes into account individual genetic and Targeted therapies in cancer treatment rely on a
molecular characteristics when devising treatment plans. deep understanding of the molecular basis of cancer.
Targeted therapies are at the forefront of precision These therapies are designed to specifically target key
medicine, as they offer personalized treatments based on genetic and molecular alterations that drive cancer cell
the unique attributes of each patient's cancer. growth and survival. By focusing on the unique
Through advanced genomic analysis and characteristics of cancer cells, targeted therapies aim to
molecular profiling, oncologists can identify specific disrupt their signaling pathways, leading to more effective
genetic alterations driving tumor growth. Armed with this and less toxic treatments.[5]
knowledge, they can select targeted therapies that are Key Genetic and Molecular Alterations in Cancer:
most likely to be effective against the identified molecular Numerous genetic and molecular alterations
targets. This individualized approach enhances treatment have been identified in different types of cancer. These
response rates while minimizing the risk of adverse alterations can promote uncontrolled cell growth, evade
reactions.[3] cell death, and enable cancer cells to spread throughout
Moreover, precision medicine allows the body. Some of the key alterations include:
oncologists to predict a patient's response to treatment 1. Oncogene activation: Oncogenes are genes that, when
more accurately. This knowledge is invaluable in mutated or overexpressed, promote cell proliferation and
optimizing treatment strategies, avoiding unnecessary survival. Examples include HER2 in breast cancer and
treatments, and improving overall patient outcomes.[4] EGFR in lung cancer.
Targeted therapies have ushered in a new era of 2. Tumor suppressor gene inactivation: Tumor suppressor
cancer treatment, providing hope for more effective and genes normally regulate cell growth and prevent tumor
less toxic interventions. The integration of targeted formation. Mutations in these genes can lead to
approaches into precision medicine has elevated patient uncontrolled cell growth. Examples include TP53 (p53)
care by tailoring treatments to individual genetic profiles. in various cancers and BRCA1/2 in breast and ovarian
As research and technology continue to advance, targeted cancer.
therapies hold the potential to transform cancer treatment 3. Dysregulated cell signaling pathways: Abnormalities in
and significantly improve patient outcomes. The future of critical signaling pathways, such as the MAPK and PI3K
cancer care lies in the continued exploration and pathways, can contribute to cancer development and
utilization of these groundbreaking therapies in the fight progression.[6]
against this complex disease.[4]

Gene Alteration Cancer Type


TP53 Mutation Many types of cancer
RB1 Mutation Retinoblastoma, breast cancer, and other types of cancer
EGFR Mutation, amplification Lung cancer, head and neck cancer, and other types of cancer
KRAS Mutation Lung cancer, colorectal cancer, and other types of cancer
BRAF Mutation Melanoma, thyroid cancer, and other types of cancer
RET Fusion Thyroid cancer, medullary thyroid cancer, and other types of cancer
ALK Fusion Lung cancer, anaplastic large cell lymphoma, and other types of cancer
NTRK1 Fusion Sarcoma, breast cancer, and other types of cancer
NTRK3 Fusion Sarcoma, breast cancer, and other types of cancer

Role of Biomarkers in Identifying Suitable Targets: 1. HER2/neu: Overexpression of HER2 in breast cancer
Biomarkers are measurable indicators that help patients is an indication for HER2-targeted therapies like
identify specific molecular alterations in a patient's tumor. trastuzumab.
2. ALK fusion: Detection of ALK gene rearrangement in
They play a vital role in guiding the selection of
non-small cell lung cancer (NSCLC) patients suggests
appropriate targeted therapies. Biomarker analysis eligibility for ALK inhibitors like crizotinib.
involves techniques such as genomic sequencing, gene 3. BRAF V600E: Presence of this mutation in melanoma
expression profiling, and protein analysis.[7] patients makes them candidates for BRAF inhibitors like
Some commonly used biomarkers in targeted vemurafenib.[8]
therapies include: Understanding the molecular basis of targeted
therapies and the role of biomarkers in identifying

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suitable treatment targets has opened up new avenues in 1. Small Molecule Inhibitors:
precision medicine. As we delve deeper into cancer Small molecule inhibitors are a class of targeted
genomics, the potential to develop more effective and therapies that interfere with specific molecules involved
personalized therapies for cancer patients continues to in cancer cell growth and survival. These inhibitors are
expand. orally administered drugs that can penetrate cells and
target intracellular signaling pathways. By binding to the
III. TYPES OF TARGETED targeted molecules, small molecule inhibitors disrupt the
THERAPIES signaling cascades, thereby halting tumor growth and
inducing cancer cell death. Examples of small molecule
inhibitors include imatinib targeting BCR-ABL in chronic
myeloid leukemia (CML) and vemurafenib targeting
BRAF V600E in melanoma.[9]

2. Monoclonal Antibodies: 3. Gene Therapies and Viral Vectors:


Monoclonal antibodies (mAbs) are engineered to Gene therapies utilize genetically modified
recognize and bind to specific proteins present on the viruses or vectors to deliver therapeutic genes into cancer
surface of cancer cells. These antibodies can mark cancer cells. The viral vectors can integrate into the cancer cell's
DNA, altering its function and inhibiting tumor growth.
cells for destruction by the immune system or directly
Additionally, these therapies can be designed to induce
interfere with cell signaling. By leveraging the immune apoptosis (programmed cell death) in cancer cells. CAR-
system's natural ability to target abnormal cells, mAbs can T cell therapy is an example of gene therapy where
induce an immune response against cancer. Notable patients' T-cells are genetically modified to express
examples include trastuzumab, an mAb targeting HER2 chimeric antigen receptors (CARs) targeting specific
in breast cancer, and rituximab targeting CD20 in B-cell antigens on cancer cells, such as CD19 in B-cell
lymphomas.[10] leukemias and lymphomas.[11,13]

Type of Targeted
How it Works Examples of Drugs
Therapy
Attach to specific targets on the surface of
Type of Targeted Trastuzumab (Herceptin), cetuximab
cancer cells, blocking their growth or ability to
Therapy (Erbitux), rituximab (Rituxan)
spread.

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Small-molecule Block the activity of specific proteins that are Imatinib (Gleevec), sunitinib (Sutent),
inhibitors involved in cancer cell growth and survival. gefitinib (Iressa)
Antiangiogenesis Block the growth of new blood vessels that Bevacizumab (Avastin), sunitinib
inhibitors tumors need to grow and spread. (Sutent), cediranib (Zactima)
Immunomodulatory Stimulate the immune system to attack cancer Ipilimumab (Yervoy), pembrolizumab
drugs cells. (Keytruda), nivolumab (Opdivo)

These different types of targeted therapies have treatment, unleashing the potential of the immune system
significantly advanced cancer treatment, offering more to fight cancer. While challenges remain, ongoing
precise and effective approaches for patients. Ongoing research and clinical efforts are dedicated to refining these
research and clinical trials continue to expand the therapies and expanding their applicability to benefit
repertoire of targeted therapies, raising hopes for further more patients with various cancer types.[18]
improvements in cancer management.[12]
V. TARGETED THERAPIES FOR
IV. IMMUNE CHECKPOINT SPECIFIC CANCER TYPES
INHIBITORS
1. Breast Cancer:
Understanding Immune Checkpoints and their Role in In breast cancer, targeted therapies focus on
Cancer: specific molecular alterations that contribute to tumor
Immune checkpoints are regulatory molecules in growth. For example, human epidermal growth factor
the immune system that maintain self-tolerance and receptor 2 (HER2)-positive breast cancer can be treated
prevent excessive immune responses against healthy with HER2-targeted therapies like trastuzumab,
tissues. However, cancer cells can exploit these pertuzumab, and ado-trastuzumab emtansine. Hormone
checkpoints to evade immune surveillance and escape receptor-positive breast cancer can be treated with
destruction. Immune checkpoint inhibitors are a class of hormonal therapies that block estrogen or progesterone
immunotherapies that target these inhibitory molecules, receptors, such as tamoxifen and aromatase
reactivating the immune response against cancer.[14] inhibitors.[19]
One of the key immune checkpoints targeted by 2. Lung Cancer:
these inhibitors is the programmed cell death protein 1 In lung cancer, targeted therapies are designed to
(PD-1) receptor and its ligand PD-L1. When PD-L1 on inhibit specific genetic mutations that drive tumor growth.
cancer cells binds to PD-1 on T cells, it inhibits T cell EGFR inhibitors like gefitinib and osimertinib are
activity, allowing cancer cells to avoid detection and effective for non-small cell lung cancer (NSCLC) patients
destruction. Immune checkpoint inhibitors block this with EGFR mutations. ALK inhibitors, such as crizotinib
interaction, enabling T cells to recognize and attack and alectinib, are used for patients with ALK gene
cancer cells effectively.[15] rearrangements. ROS1 and BRAF inhibitors are also
Successes and Challenges in Immunotherapy: emerging as targeted therapies for specific subsets of lung
The success of immune checkpoint inhibitors cancer patients.[20]
has been remarkable in several cancer types. In clinical 3. Colorectal Cancer:
trials, these therapies have shown durable responses and In colorectal cancer, targeted therapies mainly
prolonged survival rates in patients with advanced cancers focus on blocking the vascular endothelial growth factor
who had exhausted other treatment options. Notable (VEGF) pathway and the epidermal growth factor
successes include pembrolizumab and nivolumab, both receptor (EGFR). Bevacizumab is an anti-VEGF antibody
PD-1 inhibitors, which have demonstrated significant that inhibits blood vessel formation in the tumor. EGFR
efficacy in melanoma, lung cancer, and other inhibitors like cetuximab and panitumumab target the
malignancies.[16,17] EGFR pathway in KRAS wild-type colorectal cancer.[21]
Despite these successes, challenges persist in 4. Melanoma:
immunotherapy. Not all patients respond to immune In melanoma, targeted therapies are directed
checkpoint inhibitors, and tumor microenvironments can towards the BRAF mutation, which is present in about
be immunosuppressive, limiting the effectiveness of these half of all melanomas. BRAF inhibitors like vemurafenib
therapies. Biomarkers like PD-L1 expression have been and dabrafenib specifically target the mutated BRAF
used to predict response to checkpoint inhibitors, but their protein, inhibiting its activity. However, resistance can
reliability remains an area of active research. develop, so combination therapies with MEK inhibitors
Additionally, immune-related adverse events, though like trametinib have shown better efficacy.[22]
generally manageable, can occur as the immune system is 5. Leukemias and Lymphomas:
reactivated, necessitating close monitoring and For leukemias and lymphomas, targeted
management.[18] therapies include monoclonal antibodies and kinase
The development of immune checkpoint inhibitors. In chronic lymphocytic leukemia (CLL), the
inhibitors has brought a new dimension to cancer anti-CD20 antibody rituximab is used, while in B-cell
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lymphomas, it is used in combination with chemotherapy. molecular targets, leading to improved outcomes and
In chronic myeloid leukemia (CML), tyrosine kinase reduced side effects for patients. As research continues,
inhibitors like imatinib, nilotinib, and dasatinib target the the potential for further advancements in targeted
BCR-ABL fusion gene.[23] therapies is bright, offering hope for better treatments and
Targeted therapies for specific cancer types have increased survival rates.[23]
transformed cancer treatment by honing in on precise

VI. EMERGING APPROACHES AND 2. Nanoparticle-based Drug Delivery Systems:


Nanoparticle-based drug delivery systems are a
COMBINATIONS cutting-edge approach in cancer treatment. These systems
involve encapsulating anticancer drugs within tiny
1. Combination Therapies to Overcome Resistance: nanoparticles that can target specific tissues or cancer
Resistance to targeted therapies is a significant cells. Nanoparticles can protect drugs from degradation
challenge in cancer treatment. To address this, researchers and enhance their accumulation at the tumor site,
are exploring combination therapies that involve using improving treatment efficacy while minimizing systemic
toxicity.[25]
two or more drugs with complementary mechanisms of
Various types of nanoparticles, such as
action. These combinations aim to target multiple liposomes, polymeric nanoparticles, and gold
pathways involved in tumor growth, making it harder for nanoparticles, have been developed to deliver
cancer cells to develop resistance.[24] chemotherapeutic agents, targeted therapies, and even
For instance, in melanoma, combining BRAF gene therapies. The ability to load multiple drugs into
and MEK inhibitors has shown promising results in nanoparticles allows for combination therapies within a
overcoming acquired resistance to BRAF inhibitors single delivery system, maximizing the therapeutic
potential.[25]
alone. Additionally, immunotherapies like immune
Emerging approaches like combination therapies
checkpoint inhibitors are being combined with targeted and nanoparticle-based drug delivery systems hold
therapies to enhance the immune response against cancer tremendous promise in improving cancer treatment
cells while concurrently inhibiting specific molecular outcomes. As research progresses, these novel strategies
targets.[24] are expected to play an increasingly vital role in
personalized and more effective cancer therapies.

Approach Description
Immunotherapy Stimulates the immune system to attack cancer cells.
Gene therapy Delivers genes to cancer cells to either kill them or stop them from growing.
Nanomedicine Uses nanoparticles to deliver drugs or other therapies to cancer cells.
Uses information about a patient's individual cancer to tailor treatment to their specific
Precision medicine
needs.
Combination
Uses two or more therapies together to treat cancer.
therapy

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VII. CLINICAL TRIALS AND potential benefits and risks of investigational drugs or
REGULATORY LANDSCAPE therapies.
In the context of cancer treatment, clinical trials
1. Overview of Current Clinical Trials and their often focus on targeted therapies, immunotherapies, and
Outcomes: novel combinations of existing treatments. These trials
Clinical trials are essential for evaluating the aim to identify treatments that can improve patient
safety and efficacy of new cancer treatments before they outcomes, increase survival rates, and minimize adverse
can be approved for widespread use. These trials involve effects. The outcomes of clinical trials can vary, ranging
carefully designed studies in human subjects to assess the from successful results that lead to FDA approval to
inconclusive findings that may necessitate further
investigation [26].

Phase Description
Phase I Tests safety and dosage of a new drug in a small group of people.
Phase II Tests effectiveness of a new drug in a larger group of people.
Phase III Compares a new drug to standard treatment in a large group of people.
Phase IV Monitors the safety and effectiveness of a new drug after it has been approved for use.

2. FDA Approval Process and Future Directions: disease progression. Cancer cells can develop resistance
The U.S. Food and Drug Administration (FDA) to targeted therapies by acquiring new mutations or
plays a crucial role in regulating the approval and use of activating alternative pathways. This adaptability of
new cancer treatments. The FDA approval process cancer cells poses a major hurdle in achieving long-term
involves rigorous evaluation of data from preclinical control of the disease.
studies and clinical trials to ensure the safety and efficacy Tumor heterogeneity is another limitation in
of drugs before they are marketed to the public. cancer treatment. Within a single tumor, there can be a
For cancer therapies, the FDA may grant diverse population of cancer cells with varying genetic
accelerated approval for treatments that show significant and molecular characteristics. Some cells may be
benefits in early-phase trials. However, full approval may susceptible to treatment, while others are resistant,
require further verification through larger, randomized
making it challenging to effectively target all cancer cells
trials. Additionally, the FDA continuously evaluates post-
approval data to monitor the long-term safety and in a heterogeneous tumor.[28]
effectiveness of drugs. 2. Side Effects and Toxicities:
Future directions in the regulatory landscape Many cancer treatments, including
include the adoption of novel trial designs, such as basket chemotherapy and radiation therapy, can cause significant
trials and adaptive trials, to efficiently assess multiple side effects and toxicities. While these treatments target
treatments across different cancer types and patient rapidly dividing cancer cells, they can also affect healthy
populations. Moreover, efforts are underway to cells that divide quickly, such as hair follicles and cells
streamline the approval process for promising therapies, lining the digestive tract. This leads to adverse effects like
ensuring that innovative treatments reach patients in a hair loss, nausea, and fatigue, reducing the patient's
timely manner.[27]
quality of life.
The continuous progress in clinical trials and the
evolving regulatory landscape are vital for advancing Immunotherapies and targeted therapies also
cancer treatment options. By adhering to rigorous come with their own set of side effects, as they activate
standards, improving trial design, and embracing the immune system or target specific molecular pathways.
innovation, researchers and regulatory agencies can Immune-related adverse events, such as skin rashes and
enhance the efficiency and effectiveness of cancer clinical autoimmune reactions, can occur with immunotherapies,
trials, ultimately benefiting patients and providing hope requiring careful monitoring and management.[29]
for improved cancer care in the future. Addressing these challenges and limitations is
crucial to improving cancer treatment outcomes. Ongoing
VIII. CHALLENGES AND research and advances in precision medicine and
LIMITATIONS IN CANCER immunotherapy hold promise in overcoming drug
TREATMENT resistance and tumor heterogeneity. Additionally, efforts
to develop therapies with better target specificity and
1. Drug Resistance and Tumor Heterogeneity: reduced side effects are essential in enhancing patient care
Drug resistance is a significant challenge in and minimizing treatment-related toxicities.
cancer treatment that can lead to treatment failure and

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IX. FUTURE PERSPECTIVES IN specific alterations driving cancer growth and tailoring
CANCER TREATMENT treatments accordingly. Precision oncology encompasses
not only targeted therapies but also immunotherapies,
1. Personalized Medicine and Targeted Therapies: gene therapies, and other innovative approaches. It aims
The future of cancer treatment lies in to optimize patient outcomes by accounting for the
personalized medicine and targeted therapies. With individual's tumor biology, genetics, and response to
advancements in genomics and molecular profiling, treatment.
oncologists can identify specific genetic alterations and Through collaborative efforts among
molecular characteristics of each patient's tumor. This researchers, clinicians, and bioinformatics experts,
information allows for the selection of the most precision oncology is continuously evolving. New
appropriate targeted therapies tailored to the individual's biomarkers and technologies are being developed to better
unique cancer profile. predict treatment response and resistance mechanisms. In
Personalized medicine aims to optimize the future, precision oncology is expected to revolutionize
treatment outcomes by matching the right drug to the right cancer care by improving treatment efficacy and
patient. By focusing on the molecular drivers of cancer, providing more personalized and effective therapeutic
targeted therapies can achieve higher efficacy while options.[31]
reducing unnecessary treatments and minimizing side The future of cancer treatment is undoubtedly
effects. As research progresses, the repertoire of targeted promising, with personalized medicine and precision
therapies is expected to expand, covering a broader range oncology at the forefront of advancements. As research
of cancer types and molecular alterations.[30] and technology continue to progress, the vision of
2. Advancements in Precision Oncology: providing each patient with the most effective and tailored
Precision oncology, an integral part of treatment plan becomes increasingly attainable, paving
personalized medicine, revolves around identifying the way for improved cancer outcomes and a brighter
future in oncology.

Area of Research Potential Benefits


Immunotherapy Harnessing the body's own immune system to fight cancer.
Gene therapy Delivering genes to cancer cells to either kill them or stop them from growing.
Nanomedicine Using nanoparticles to deliver drugs or other therapies to cancer cells.
Precision medicine Tailoring cancer treatment to the individual patient's cancer.
Combination therapy Using two or more therapies together to treat cancer.
Early detection Finding cancer early, when it is more treatable.
Prevention Developing ways to prevent cancer from developing in the first place.

X. CONCLUSION individual's unique tumor characteristics, leading to more


personalized and effective therapies.[32]
In conclusion, targeted therapies have emerged
as a revolutionary approach in cancer treatment, offering POTENTIAL IMPACT OF TARGETED
new hope for improved patient outcomes. Throughout this THERAPIES ON CANCER TREATMENT
discussion, we have explored the significant impact of
targeted therapies in various cancer types and the The potential impact of targeted therapies on
potential they hold for personalized and precise treatment. cancer treatment is immense. As research advances and
Recapitulation of Key Findings: more targeted therapies are developed, the landscape of
We have seen that targeted therapies, such as cancer care is expected to undergo a transformative shift.
small molecule inhibitors and monoclonal antibodies, The promise of personalized medicine and precision
have shown remarkable success in cancers like breast oncology offers hope for improved survival rates, better
cancer, lung cancer, colorectal cancer, melanoma, and quality of life for patients, and a reduced burden of side
leukemias/lymphomas. By specifically targeting key effects.
genetic and molecular alterations driving cancer growth, By overcoming drug resistance and tumor
these therapies have demonstrated higher efficacy and heterogeneity, targeted therapies may provide long-term
reduced toxicities compared to conventional treatments. control of cancer and increase the likelihood of achieving
Moreover, we discussed the importance of complete remission in certain cases. Additionally, the
biomarkers in identifying suitable targets for treatment integration of targeted therapies with other treatment
and the integration of targeted therapies into precision modalities, such as immunotherapies and combination
medicine. The use of biomarkers and genomic profiling therapies, has the potential to further enhance treatment
allows oncologists to tailor treatments based on an outcomes.[32]

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