Parmar Vani, Nair Nita S, Thakkar Purvi, Chitkara Garvit
Breast Unit, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer, Kharghar, Navi Mumbai, Maharashtra 410210 India.
Breast Unit, Tata Memorial Centre, Tata Memorial Hospital, Ernest Borges Rd, Parel, Mumbai, 400012 India.
Indian J Surg Oncol. 2021 Apr;12(Suppl 1):7-20. doi: 10.1007/s13193-019-00954-1. Epub 2019 Aug 10.
Breast cancer is no longer considered a single disease, and with better understanding of cancer biology, its management has evolved over the years, into a complex individualized use of therapeutics based on variable expressions of predictive and prognostic factors. With the advent of molecular and genetic research, the complexity and diversity of breast cancer cells and their ability to survive and develop resistance to treatment strategies became more evident. At the same time, targeted therapies evolved, as specific targets were discovered such as HER2 receptor, and androgen receptor. More recent is the development of immunotherapy which aims at strengthening the host immune system to identify and kill the tumor cells. In breast cancer treatment, use of molecular tests has been a target of controversies, due to their high costs and inaccessibility in limited resource situations. Research in breast cancer is also proceeding at a rapid pace, but it is important to remember that breast cancer continues to be a complex interplay of alterations at molecular and genetic level, with the variability in expressions at protein level leading to difference in behavior and responses to treatment and overall outcome. In the succeeding paragraphs, we will try to review the available evidence in literature and attempt to understand the molecular complexity of breast cancer in order to simplify the art of treating the disease and improving outcomes.
乳腺癌不再被视为单一疾病,随着对癌症生物学的深入了解,多年来其治疗方法不断演变,发展为基于预测和预后因素的不同表达而进行的复杂个体化治疗。随着分子和基因研究的出现,乳腺癌细胞的复杂性和多样性以及它们在面对治疗策略时存活和产生耐药性的能力变得更加明显。与此同时,靶向治疗不断发展,因为发现了诸如HER2受体和雄激素受体等特定靶点。最近出现的免疫疗法旨在增强宿主免疫系统以识别和杀死肿瘤细胞。在乳腺癌治疗中,分子检测的使用一直存在争议,原因在于其成本高昂且在资源有限的情况下难以获得。乳腺癌研究也在快速推进,但必须记住,乳腺癌在分子和基因水平上仍然是多种改变的复杂相互作用,蛋白质水平表达的变异性导致其行为、对治疗的反应以及总体结果存在差异。在接下来的段落中,我们将尝试回顾文献中的现有证据,并试图理解乳腺癌的分子复杂性,以便简化治疗该疾病的方法并改善治疗效果。