Piccart-Gebhart M J, Sotiriou C
Department of Medicine, Jules Bordet Institute, Brussels, Belgium.
Ann Oncol. 2007 Dec;18 Suppl 12:xii2-7. doi: 10.1093/annonc/mdm532.
The question of whether to offer adjuvant chemotherapy to patients with early-stage breast cancer continues to challenge clinicians on a daily basis. Many patients with node-negative or low-risk breast cancer could be spared the trauma of receiving chemotherapy, but more reliable prognostic markers are still needed to aid our therapy decision making. Gene expression profiling is a welcome product of the 'omic' era and several multi-gene expression panels ('signatures') have now been developed that show promise in predicting which breast cancer patients are likely to develop metastatic disease if adjuvant chemotherapy is not administered. The value of gene expression profiling as a prognostic tool in clinical practice is currently being appraised more fully in two large, prospective, randomised studies--TAILORx and MINDACT. These studies should provide level I evidence of the prognostic power of gene expression profiling and will hopefully allow us to one day quantify risk of progression in the individual patient and tailor treatment accordingly. Genetic profiling of circulating tumour cells and micrometastases should further enhance our understanding of breast cancer biology and allow us to personalise therapy based on functional maps of critical tumour pathways. Close collaboration between clinicians and scientists will be essential to achieve this goal.
对于早期乳腺癌患者是否提供辅助化疗的问题，每天都在持续挑战着临床医生。许多淋巴结阴性或低风险乳腺癌患者可以避免接受化疗的创伤，但仍需要更可靠的预后标志物来辅助我们进行治疗决策。基因表达谱分析是“组学”时代令人欣喜的成果，目前已经开发出几种多基因表达谱（“特征”），在预测哪些乳腺癌患者若不进行辅助化疗可能发生转移性疾病方面显示出前景。基因表达谱分析作为一种预后工具在临床实践中的价值，目前正在两项大型、前瞻性、随机研究——TAILORx和MINDACT中得到更全面的评估。这些研究应能提供关于基因表达谱分析预后能力的一级证据，有望让我们有朝一日能够量化个体患者的疾病进展风险并据此调整治疗方案。循环肿瘤细胞和微转移灶的基因谱分析应能进一步加深我们对乳腺癌生物学的理解，并使我们能够基于关键肿瘤通路的功能图谱实现个性化治疗。临床医生和科学家之间的密切合作对于实现这一目标至关重要。
