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Table 4 Summary of the gap analysis for the therapies and targets in breast cancer

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.