Personalized therapy in breast cancer
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Published on: February 23, 2024
Frederik Marmé1, Andreas Schneeweiss
1Department of Gynaecology and Obstetrics, National Center for Tumour Diseases, University of Heidelberg, Germany.
Abstract:
Systemic treatment of non-metastatic breast cancer is based on endocrine therapy, cytotoxic chemotherapy, and molecular targeted therapy - with the major problems of immense overtreatment of patients who would not relapse without systemic therapy and the failure of treatment in others whose disease still recurs. These deficits can only be overcome by the identification of new and better prognostic and predictive markers. Currently, adjuvant treatment stratification is based on a limited number of established factors, namely locoregional tumour stage, age, grade, expression of hormone receptors, HER2, and Ki-67. Molecular profiling techniques, however, have revolutionized our understanding of breast cancer as a heterogeneous disease. Future results from even more comprehensive genetic analyses as part of the coordinated cancer genome projects will help to develop better treatment stratifications and new therapeutic approaches. Efforts to realize the dream of a personalized treatment for breast cancer will include drug development and intelligent design of trials for increasingly small subgroups of patients with specific host and disease characteristics. This will only be made possible by a strong cooperation between basic researchers and translational scientists, clinicians, as well as academia and industry.
Insights
Identifying new prognostic and predictive markers is crucial for optimizing systemic treatment of non-metastatic breast cancer. This will reduce overtreatment and improve outcomes for patients whose disease recurs.
Area of Science:
- Oncology
- Genomics
- Personalized Medicine
Background:
- Current systemic treatments for non-metastatic breast cancer (endocrine therapy, chemotherapy, targeted therapy) face challenges of overtreatment and treatment failure.
- Existing adjuvant treatment stratification relies on limited factors: tumor stage, age, grade, hormone receptors, HER2, and Ki-67.
- Breast cancer is a heterogeneous disease, necessitating improved markers for accurate patient stratification.
Purpose of the Study:
- To highlight the critical need for novel prognostic and predictive markers in non-metastatic breast cancer.
- To emphasize the role of molecular profiling and comprehensive genetic analyses in advancing treatment strategies.
- To advocate for personalized treatment approaches through drug development and tailored clinical trials.
Main Methods:
- Review of current systemic treatment modalities and their limitations in non-metastatic breast cancer.
- Discussion of established factors used in adjuvant treatment stratification.
- Exploration of molecular profiling techniques and future genetic analyses (e.g., cancer genome projects).
Main Results:
- Molecular profiling has significantly advanced the understanding of breast cancer heterogeneity.
- Comprehensive genetic analyses are expected to yield better treatment stratifications and novel therapeutic targets.
- Personalized treatment requires drug development and clinical trials focused on specific patient subgroups.
Conclusions:
- Improved prognostic and predictive markers are essential to overcome current treatment deficits in non-metastatic breast cancer.
- Advanced genomic studies will pave the way for more precise treatment strategies and personalized medicine.
- Strong collaboration between researchers, clinicians, academia, and industry is vital for realizing personalized breast cancer treatment.
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