J.Jpn. Surg. Soc.. 124(3): 239-245, 2023

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Feature topic

CURRENT STATUS AND FUTURE PROSPECTS OF STRATIFIED MEDICINE FOR BREAST CANCER

Breast cancer is the most common malignancy in women. Its treatment outcomes have improved significantly due to advances in biology-based pharmacotherapy in addition to local surgery and radiotherapy. In the 1960s and 1970s, chemotherapy and hormonal therapy were found to be effective in preventing recurrence and prolonging survival rates, and the importance of determining predictive factors for therapeutic efficacy and selecting appropriate treatment methods was recognized. Since 2000, gene expression profiling using cDNA microarrays has revealed that there are various subtypes of breast cancer, and this concept has brought about a major change in therapy. In clinical practice, indications for endocrine therapy, anti-HER2 therapy, PARP inhibitors, immune checkpoint inhibitors, and other molecular-targeted therapies are being determined by predictive factors such as hormone receptors, HER2 protein overexpression, proliferative activity, and multigene assays. In the future, more appropriate treatment will be selected through stratification and individualization. Elucidation of proliferation and metastasis mechanisms, development of new drugs, and clinical trial results have contributed to progress in overcoming resistance. Advances in response-guided therapy, genomic medicine, and escalation and deescalation therapy are expected to yield further improvement in treatment results.

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