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This preferred scenario recognizes that the new generation of molecularly targeted drugs has the potential for personalized medicine and the possibility of more efficacious and less toxic antitumor therapies in patients who have defined molecular aberrations.

Key molecular targets or pathways which are vital to certain Hedgehog inhibitor cancers, or that present opportunities for synthetic lethality, should be actively pursued and dissected to improve our understanding of a personalized approach as they could be used to examine intra and inter patient tumor molecular heterogeneity and assist selection of an optimal anticancer therapy for each individual patient. Moreover, these biomarkers could be increasingly used as intermediate endpoints of response. The upfront use and testing of putative predictive biomarkers in early clinical trial programs could minimize any possible need for retrospective subgroup dredging for predictive biomarkers in later phase trials carried out in unselected populations. Selecting patients based on molecular predictors may help minimize the risk of late and costly drug attrition due to disease heterogeneity, accelerate patient benefit, and could also accelerate the drug approval process, which currently remains slow and inefficient.

Several studies have focused on Hedgehog inhibitor the combination of c MET inhibitors and agents targeting ErbB family members, with the rationale for this approach based on evidence of crosstalk between c METand other EGFR family members. In addition, cancers codependent on both c MET and EGFR signaling have also been identified, with MET amplification detected in patients with NSCLC who have clinically developed resistance to the EGFR inhibitors gefitinib or erlotinib. Several clinical trials are currently under way, which aim to determine if the combination of c MET TKIs with EGFR, VEGF, or chemotherapy is a clinically effective therapeutic approach.

However, the use of conventional chemotherapy is often limited by de novo or acquired resistance, Hedgehog inhibitor typically resulting from increased growth factor receptor signaling. These observations have prompted growth factor receptor inhibitors to be evaluated in combination with chemotherapy. Successful clinically validated examples of this approach include cetuximab, an anti EGFR antibody, in colorectal cancer and trastuzumab in patients with ERBB2 amplified breast cancer.