Precision medicine is changing how patients are treated and how therapies are developed. In recent years, biomarker-directed targeted designs have been developed for pharmaceutical development aimed at patient subpopulations with specific disease etiologies. Some statistical issues remain to be answered in this area. One new development is to integrate multistage testing into the targeted designs, which enhances flexibility of targeted trials by enabling sequential monitoring and stochastic curtailment. Another area of interest is potential impact of performance of a biomarker or diagnostic decision rule, used to select target patients, on statistical planning and operating characteristics of a targeted trial. Recently, a two-stage adaptive targeted trial design has been proposed for biomarker performance monitoring and biomarker performance-based sample size re-estimation. In this roundtable discussion, we intend to promote communication, among statisticians from industry, academia, and regulatory agencies, on the key issues in the area of biomarker-directed targeted design. The topics include but are not limited to practical considerations for targeted trial designs, statistical methods for biomarker evaluation, multistage adaptive design for targeted trials, biomarker performance monitoring during a targeted trial, and adaptive design for biomarker performance-based sample size re-estimation.