Research priorities in prediction of response in early breast cancer

With increasingly effective treatments, breast cancer outcomes have markedly improved, so goals of research in the modern era must be to tailor treatment to risk and response - we must escalate therapy in those who need better, more effective drugs, but we must also de-escalate therapy in those who are overtreated by current approaches. Research priorities in the upcoming years will be to better identify tumor biologic features conferring a high sensitivity to drugs, thereby allowing more tailored and less aggressive regimens, as well as tumor features conferring resistance to drugs, which can be then be omitted. The neoadjuvant approach to therapy, which has become the standard for HER2-positive and triple negative breast cancer, has already given us response-tailored therapy through the advent of residual disease strategies; we will need to learn to leverage this approach even more to further tailor treatment and maximize clinical benefit.