Optimizing diagnostics for patient tailored treatment choices in patients with metastatic renal cell carcinoma and breast cancer

Providing personalized cancer treatment is an important aim in current cancer care. The ultimate goal is to choose the right treatment for the right patient at the right time. However, with an increasing number of new cancer drugs, there is an unmet need for predictive biomarkers to support proper decision making. In the thesis “Optimizing diagnostics for patient tailored treatment choices in patients with metastatic renal cell carcinoma and breast cancer”, several studies are described that evaluate the role of specific PET scans in staging renal cell carcinoma and in predicting the efficacy of different treatment options of metastatic renal cell carcinoma. In the field of breast cancer PET scans could also possibly contribute, however, because it is difficult to conduct trials with PET scans, the implementation of new PET scans stays behind. I analyse where we stand currently and suggest how to bring more PET scans to the clinic. Most patients with metastatic breast cancer have bone involvement. Lastly, I analyse different methods of routine assessments for bone metastases with the goal to get as much out of existing diagnostics as possible. I conclude that decalcification of bone metastases with one specific agent does not affect the pathological results and thus is safe to use while other agents are not. Furthermore, I find that 18F-FDG PET performs better than bone scintigraphy as assessment for bone metastases at first presentation of metastatic breast cancer.