Precision medicine revolutionizes breast cancer treatment: tailored therapies improve outcomes across subtypes

Breast cancer, one of the most prevalent and biologically diverse malignancies globally, has historically posed significant treatment challenges due to its diverse molecular subtypes. Traditional “one-size-fits-all” approaches often resulted in suboptimal outcomes, particularly for aggressive or advanced cases. The advent of precision medicine has revolutionized treatment by enabling personalized therapeutic strategies based on specific biomarkers and genetic alterations.

In a comprehensive review published in Cancer Biology & Medicine (DOI: 10.20892/j.issn.2095-3941.2024.0510)，researchers from Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University & Peking University Cancer Hospital Yunnan, detailed recent advances in precision medicine for breast cancer. The study outlines significant progress for each subtype:

HR+/HER2- breast cancer: CDK4/6 inhibitors (e.g., palbociclib, abemaciclib, ribociclib, and dalpiciclib) combined with endocrine therapy have shown significant improvements in invasive disease-free survival (iDFS), especially in high-risk early-stage patients. For patients with PIK3CA mutations, PI3K inhibitors like alpelisib offer effective options. Immunotherapy is also showing promise for high-risk cases in clinical trials (e.g., KEYNOTE-756, CheckMate 7FL). Breast Cancer Index (BCI) helps guiding extended endocrine therapy duration.

HER2-positive breast cancer: Dual HER2 blockade (trastuzumab + pertuzumab) remains the first-line standard for early breast cancers. Antibody-drug conjugates (ADCs) like T-DXd (trastuzumab deruxtecan) and T-DM1 (trastuzumab emtansine) demonstrate superior efficacy, including in HER2-low disease and for residual disease post-neoadjuvant therapy. Tyrosine kinase inhibitors (TKIs) like tucatinib and the China-developed pyrotinib are effective against brain metastases. Neratinib is approved for extended adjuvant therapy.

Triple-negative breast cancer (TNBC): Immunotherapy, particularly immune checkpoint inhibitors (e.g., pembrolizumab, atezolizumab), has improved pathological complete response (pCR) rates and survival (EFS, OS) in early-stage disease. PARP inhibitors (e.g., olaparib) benefit patients with BRCA mutations. ADCs like sacituzumab govitecan provide new hope for advanced cases. Molecular subtyping (e.g., Fudan Classification) guides targeted approaches.

The integration of advanced diagnostics, such as liquid biopsy for real-time monitoring and molecular imaging for precise tumor visualization, further enhances personalized treatment planning and response assessment.

Dr. Guojun Zhang, the corresponding author, stated: “Precision medicine has become a cornerstone of modern breast cancer treatment, offering more effective, less invasive, and highly personalized care. The integration of advanced diagnostics and targeted therapies holds great promise for improving patient outcomes and revolutionizing cancer management.”

The review has significant implications for the future of breast cancer care. By identifying specific molecular targets and developing corresponding therapies, clinicians can provide more precise and effective treatments, leading to improved survival rates and quality of life. The continued exploration and application of these precision approaches, alongside emerging technologies like artificial intelligence (AI), cell-based therapies (e.g., CAR-T, TIL), and mRNA-based innovations, are expected to further advance the field, paving the way for even more individualized and effective breast cancer treatments.

Funding information

This work was supported by grants from the National Natural Science Foundation of China (Grant Nos. 82103614 and 32171363), Natural Science Foundation of Fujian Province of China (Grant No. 2021J05007), start-up funds for Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer and Xiamen’s Key Laboratory of Precision Medicine for Endocrine-Related Cancers, start-up and supporting funds from the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital for Guo-Jun Zhang and Jing-Wen Bai, Key Research and development program for social development of Yunnan Science and Technology Department (Grant No. 202403AC100014-2), and horizontal project funding from the Third Affiliated Hospital of Kunming Medical University (Grant Nos. 20233160A0866 and 20243160A0511).

About Cancer Biology & Medicine

Cancer Biology & Medicine (CBM) is a peer-reviewed open-access journal sponsored by China Anti-cancer Association (CACA) and Tianjin Medical University Cancer Institute & Hospital. The journal monthly provides innovative and significant information on biological basis of cancer, cancer microenvironment, translational cancer research, and all aspects of clinical cancer research. The journal also publishes significant perspectives on indigenous cancer types in China. The journal is indexed in SCOPUS, MEDLINE and SCI (IF 8.4, 5-year IF 6.7), with all full texts freely visible to clinicians and researchers all over the world (http://www.ncbi.nlm.nih.gov/pmc/journals/2000/).