Güler E Nilüfer
Department of Medical Oncology, Hacettepe Cancer Institute, Ankara, Turkey.
Eur J Breast Health. 2017 Oct 1;13(4):168-174. doi: 10.5152/ejbh.2017.3636. eCollection 2017 Oct.
Breast cancer is a heterogeneous disease. The purpose of adjuvant therapy for early-stage breast cancer is to provide maximum benefit with minimum side effects and not to under-treat or over-treat. The clinical progresses of patients with the same clinical and pathological characteristics who are given similar treatments may show major differences. This fact indicates that the prognostic and predictive factors that we have used until recent years for therapy selection are not really sufficient, we need new markers, every disease and every individual are unique and that treatment should be individualized. The gene expression profiling, which has come into clinical use in recent years, is beneficial in therapy selection for luminal breast cancer cases. A differentiation can be made among patients for whom only endocrine treatment would be adequate and those who should also receive chemotherapy in addition to endocrine treatment. Several new gene expression analysis studies targeted at gaining the ability to determine drug selection in chemotherapy, endocrine treatment and neo-adjuvant therapy are also currently ongoing. The staging system for new breast cancer that is to be published in the year 2018 also includes gene expression analyses within the prognostic panel and the stage changes depending on the result. The statement 'Treat the patient, not the disease.' is becoming increasingly entrenched in our clinical practice. This article briefly summarizes the gene expression profiles, which are validated and used in the selection of therapy for early-stage breast cancer.
乳腺癌是一种异质性疾病。早期乳腺癌辅助治疗的目的是以最小的副作用提供最大的益处，而不是治疗不足或过度治疗。接受相似治疗的具有相同临床和病理特征的患者，其临床进展可能存在显著差异。这一事实表明，直到近年来我们用于治疗选择的预后和预测因素并不真正充分，我们需要新的标志物，因为每种疾病和每个个体都是独特的，治疗应该个体化。近年来已应用于临床的基因表达谱分析，有助于管腔型乳腺癌病例的治疗选择。可以区分出仅接受内分泌治疗就足够的患者和除内分泌治疗外还应接受化疗的患者。目前也正在进行几项新的基因表达分析研究，旨在获得在化疗、内分泌治疗和新辅助治疗中确定药物选择的能力。将于2018年发布的新乳腺癌分期系统在预后评估中也纳入了基因表达分析，并根据结果改变分期。“治疗患者，而非疾病”这一观点在我们的临床实践中日益深入人心。本文简要总结了在早期乳腺癌治疗选择中得到验证并应用的基因表达谱。
