Using Breast Cancer Gene Expression Signatures in Clinical Practice: Unsolved Issues, Ongoing Trials and Future Perspectives

The development of gene expression signatures since the early 2000′s has offered standardized assays to evaluate the prognosis of early breast cancer. Five signatures are currently commercially available and recommended by several international guidelines to individualize adjuvant chemotherapy decisions in hormone receptors-positive/HER2-negative early breast cancer. However, many questions remain unanswered about their predictive ability, reproducibility and external validity in specific populations. They also represent a new hope to tailor (neo)adjuvant systemic treatment, adjuvant radiation therapy, hormone therapy duration and to identify a subset of patients who might benefit from CDK4/6 inhibitor adjuvant treatment. This review will highlight these particular issues, address the remaining questions and discuss the ongoing and future trials.

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Beyond Chemotherapies: Recent Strategies in Breast Cancer Treatment

Cancers ◽

10.3390/cancers12092634 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2634

Author(s):

Arthur Foulon ◽

Pierrick Theret ◽

Lise Rodat-Despoix ◽

Philippe Kischel

Keyword(s):

Breast Cancer ◽

Gene Expression ◽

Cancer Biology ◽

Kinase Inhibitors ◽

Chemotherapy Regimen ◽

Systemic Treatment ◽

Chemotherapeutic Drugs ◽

Biological Factors ◽

Gene Expression Signatures ◽

Therapeutic Molecules

In 2018, about 2.1 million women have been diagnosed with breast cancer worldwide. Treatments include—among others—surgery, chemotherapy, radiotherapy, or endocrine therapy. The current policy of care tends rather at therapeutic de-escalation, and systemic treatment such as chemotherapies alone are not systematically considered as the best option anymore. With recent advances in the understanding of cancer biology, and as a complement to anatomic staging, some biological factors (assessed notably via gene-expression signatures) are taken into account to evaluate the benefit of a chemotherapy regimen. The first aim of this review will be to summarize when chemotherapies can be avoided or used only combined with other treatments. The second aim will focus on molecules that can be used instead of chemotherapeutic drugs or used in combination with chemotherapeutic drugs to improve treatment outcomes. These therapeutic molecules have emerged from the collaboration between fundamental and clinical research, and include molecules, such as tyrosine kinase inhibitors, CDK4/6 inhibitors, and monoclonal antibodies (such as anti-PD-L1). In the fight against cancer, new tools aiding decision making are of the utmost importance: gene-expression signatures have proven to be valuable in the clinic, notably, to know when chemotherapies can be avoided. When substitution treatments are also available, a big step can be made toward personalized medicine for the patient’s benefit.

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Systemic Treatment Preoperatively vs Postoperatively in HER2 Positive Early Breast Cancer

Case Medical Research ◽

10.31525/ct1-nct04249440 ◽

2020 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Systemic Treatment ◽

Her2 Positive

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Downregulation of Breast Cancer Gene Expression by Small Molecule Drugs

10.21236/ada427817 ◽

2004 ◽

Author(s):

Y. V. Gopal

Keyword(s):

Breast Cancer ◽

Gene Expression ◽

Small Molecule ◽

Cancer Gene ◽

Small Molecule Drugs ◽

Breast Cancer Gene

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Gene Expression Assay in the Management of Early Breast Cancer

Current Medicinal Chemistry ◽

10.2174/0929867326666191205163329 ◽

2020 ◽

Vol 27 (17) ◽

pp. 2826-2839 ◽

Cited By ~ 2

Author(s):

Roberta Caputo ◽

Daniela Cianniello ◽

Antonio Giordano ◽

Michela Piezzo ◽

Maria Riemma ◽

...

Keyword(s):

Breast Cancer ◽

Gene Expression ◽

Decision Making ◽

Adjuvant Chemotherapy ◽

Early Breast Cancer ◽

Treatment Decision ◽

Endocrine Treatment ◽

Expression Ratio ◽

Treatment Decision Making ◽

Low Sensitivity

The addition of adjuvant chemotherapy to hormonal therapy is often considered questionable in patients with estrogen receptor-positive early breast cancer. Low risk of disease relapse after endocrine treatment alone and/or a low sensitivity to chemotherapy are reasons behind not all patients benefit from chemotherapy. Most of the patients could be exposed to unnecessary treatment- related adverse events and health care costs when treatment decision-making is based only on classical clinical histological features. Gene expression profile has been developed to refine physician’s decision-making process and to tailor personalized treatment to patients. In particular, these tests are designed to spare patients the side effects of unnecessary treatment, and ensure that adjuvant chemotherapy is correctly recommended to patients with early breast cancer. In this review, we will discuss the main diagnostic tests and their potential clinical applications (Oncotype DX, MammaPrint, PAM50/Prosigna, EndoPredict, MapQuant Dx, IHC4, and Theros-Breast Cancer Gene Expression Ratio Assay).

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