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Future perspectives of surgical treatment of breast cancer.

ABSTRACT: Breast cancer is a heterogenous disease which requires updates on scientific research to offer patients the best possible and personalized treatment. Modern surgical treatment of breast cancer is recently been reviewed and it is clearly a field of continuous change and improvement. The change in treatment strategies is a challenge given that prognosis is already acceptable. The collaboration between specialties across different countries is needed to exchange experience and improve international guidelines. Multidisciplinary teams are mandatory for the patient to be provided with all treatment options and to make an informed decision on their treatment. The major trend in surgical treatment of breast cancer is de-escalating surgery and more focus on tumor biology. A "one-size-fits all" approach does not apply in treatment of breast cancer today. There are two major questions in future aspects of breast cancer treatment; Can surgery in the breast be omitted in patients with a pathological complete response after neoadjuvant therapy? And can some patients be spared axillary surgery? The timing of surgery is also debatable. These are major questions that need to be answered and through randomized controlled trials. This commentary gives an insight on thoughts and scientific research with focus on future aspects of breast cancer treatment.

SUBMITTER: Riis M

PROVIDER: S-EPMC7509585 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Future perspectives of surgical treatment of breast cancer.

Riis Margit M

Annals of medicine and surgery (2012) 20200916

Breast cancer is a heterogenous disease which requires updates on scientific research to offer patients the best possible and personalized treatment. Modern surgical treatment of breast cancer is recently been reviewed and it is clearly a field of continuous change and improvement. The change in treatment strategies is a challenge given that prognosis is already acceptable. The collaboration between specialties across different countries is needed to exchange experience and improve international ...[more]

PMID: 33005399

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Project description:Triple-negative breast cancer (TNBC), characterized by the absence or low expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER2), is the most aggressive subtype of breast cancer. TNBC accounts for about 15% of breast cancer cases in the U.S., and is known for high relapse rates and poor overall survival (OS). Chemo-resistant TNBC is a genetically diverse, highly heterogeneous, and rapidly evolving disease that challenges our ability to individualize treatment for incomplete responders and relapsed patients. Currently, the frontline standard chemotherapy, composed of anthracyclines, alkylating agents, and taxanes, is commonly used to treat high-risk and locally advanced TNBC. Several FDA-approved drugs that target programmed cell death protein-1 (Keytruda) and programmed death ligand-1 (Tecentriq), poly ADP-ribose polymerase (PARP), and/or antibody drug conjugates (Trodelvy) have shown promise in improving clinical outcomes for a subset of TNBC. These inhibitors that target key genetic mutations and specific molecular signaling pathways that drive malignant tumor growth have been used as single agents and/or in combination with standard chemotherapy regimens. Here, we review the current TNBC treatment options, unmet clinical needs, and actionable drug targets, including epidermal growth factor (EGFR), vascular endothelial growth factor (VEGF), androgen receptor (AR), estrogen receptor beta (ERβ), phosphoinositide-3 kinase (PI3K), mammalian target of rapamycin (mTOR), and protein kinase B (PKB or AKT) activation in TNBC. Supported by strong evidence in developmental, evolutionary, and cancer biology, we propose that the K-RAS/SIAH pathway activation is a major tumor driver, and SIAH is a new drug target, a therapy-responsive prognostic biomarker, and a major tumor vulnerability in TNBC. Since persistent K-RAS/SIAH/EGFR pathway activation endows TNBC tumor cells with chemo-resistance, aggressive dissemination, and early relapse, we hope to design an anti-SIAH-centered anti-K-RAS/EGFR targeted therapy as a novel therapeutic strategy to control and eradicate incurable TNBC in the future.

Dataset Information

Future perspectives of surgical treatment of breast cancer.

Publications

Future perspectives of surgical treatment of breast cancer.

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