Recent breast cancer advancements
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Research News for 2019
In extraordinary-stage HER2-positive BC, neoadjuvant vancer with a combination of psychology and anti-HER2 targeted pigeon is currently the logo supreme Protecting aromatase-inhibitor endorsed therapy to 10 ratings.
Molecular subtype of breast cancer Breast cancer is a heterogeneous disease. An understanding of the tumour biology has been made possible from gene expression array analysis, leading to the identification of different intrinsic subtypes that exhibit different tumour behaviour with different prognoses, and that may require specific targeted therapies to maximise treatment effectiveness. Clinical assays using immunohistochemistry measure surrogates that are used to differentiate the different biological subtypes and guide treatment.
The development of the first anti-HER2—targeted therapy with trastuzumab more than 15 years ago has significantly improved the survival of breast cancer patients in both neoadjuvant, adjuvant, and metastatic settings. It showed that T-DM1 was well tolerated and, despite heavy pretreatment with anti-HER2 agents and cytotoxic chemotherapy, a meaningful achievement of progression-free survival of 6 months was achieved. Neratinib, a tyrosine kinase inhibitor, given after trastuzumab has been shown to reduce the risk of recurrence or death when compared with placebo, leading to a promising future for advanced HER2-positive breast cancer.
Tamoxifen, a selective oestrogen receptor modulator, was the first targeted therapy and has been used for more than 30 years to treat these hormone receptor—positive breast cancers. The use of these new agents has improved disease-free and overall survival. Extended use of endocrine therapy using 10 years of tamoxifen 10 or 5 years of tamoxifen followed by 5 years of aromatase inhibitors 11 has been reported to reduce recurrence and mortality. For breast cancer with high risk of recurrence, continuation of endocrine therapy beyond 5 years should be considered, provided the side-effects of treatment are tolerable.
Immunotherapy The promising results of immunotherapy in treating non—small-cell lung cancer and other cancers have led to clinical trials in breast cancer. An improved clinical activity has been observed in treating triple-negative breast cancer and those expressing PD-L1. Less-extensive surgery for appropriate cancer Regular breast screening introduced in the s has allowed detection of early breast cancer that may not require total mastectomy or complete axillary dissection, thereby reducing long-term morbidity. Long-term follow-up in studies started in the s showed that breast-conserving surgery coupled with radiation has an equivalent outcome to total mastectomy in terms of survival.
The development of sentinel node biopsy in the mids has led to its use in clinically node-negative tumours, thereby reducing the occurrence of lymphoedema that can cause long-term complications in breast cancer survivors. This approach has become increasingly adopted in many medical centres despite the criticism of under-recruitment of study cases.
For patients who still require total mastectomy for multicentric early disease, total skin-sparing mastectomy with preservation of the nipple areolar complex has shown no difference in local recurrence. It allows immediate breast reconstruction and maximises the aesthetic outcome of treatment. New approach in radiotherapy Short-course radiot