6 advances in breast cancer diagnosis and treatment

乳腺癌remains one of the two most-common types of cancer in the world, according to the World Health Organization. It’s the fifth-leading cause of cancer-related deaths annually. And more than 265,000 people will be diagnosed with it in the United States alone, during any given year.

但是，我们有理由希望。乐动体育LDsports中国研究已取得了一些令人振奋的发展breast cancer diagnosisandtreatment这将提高乳腺癌患者的生活几年来。我们采访了我们的Senthil Damodaran,医学博士,博士,Jennifer Litton, M.D.和安东尼卢奇，医学博士,to learn more.

1.Node preservationreduces lymphedema cases

Axillary lymph nodes used to be removed from the armpit routinely during breast cancersurgery测试对于转移。这导致chronic pain, numbness andlymphedemain about 1 in 5 patients. But studies have shown that many of those nodes can be preserved — without compromising long-term survival rates.

Sentinel node mapping让医生确定哪些淋巴结最有可能由肿瘤的影响。有针对性的腋窝淋巴结清扫使医生能够潜在地保留，一旦检测呈阳性的癌症，但恢复到负状态化疗或其他治疗后的节点。在这两种情况下，如果测试来对癌症呈阴性取出最初的几个节点上，剩余的节点可以单独留在家中。这意味着，并发症少，少ldsports乐动体育 我们的乳腺癌患者。

“About 15-20% of patients developed lymphedema when we were still routinely taking all the nodes out,” says Lucci, a surgical oncologist who specializes in breast cancer. “But when sentinel node mapping is done, and the rest of the nodes are left in place, that figure drops to 5%. And the chance of a recurrence in the axilla is quite small using this strategy. So, this is a huge deal. We’ve really been able to improve patients’ quality of life by dialing back our aggressiveness on routine lymph node removal.”

2.Genomic testing minimizes chemotherapy exposure

For years, many patients also got化疗作为一部分的乳腺癌治疗。但是，2018年7月的研究中新英格兰医学杂志showed that chemotherapy wouldn’t benefit up to 85% of patients over age 50 whose breast cancer was HR+, HER- and had not spread to any lymph nodes.

The study involved a genomic assay (or OncotypeDX test) that looked at the expression of 21 different genes in a patient’s primary tumor. A tumor’s gene expression pattern shows whether or not it will be responsive to chemotherapy, or whether endocrine therapy alone (such as tamoxifen) would be a better choice. The study showed that patients scoring in the low-to-mid-risk range could safely skip chemotherapy, avoiding the脱发,neuropathy,减肥and otherldsports乐动体育 往往随之而来。

“Before that study, we didn’t know if it was safe to omit chemotherapy,” says Lucci. “Now, we know we can get the same overall outcome by doing less. So, we’re minimizing overtreatment. And it has totally changed how we practice medicine.”

3.遗传性癌症综合征的鉴别更好

A number of genetic mutations — such as BRCA1 and BRCA2 — are already known to increase a person’s risk of developing certain cancers, including breast cancer. But now, next-generation gene sequencing techniques are helping researchers identify otherhereditary cancer syndromesthat can put people at risk.

“We always knew there were certain families with strong histories of cancer,” says Litton, a medical oncologist who specializes in breast cancer genetics. “But by analyzing blood and saliva, we can reach out to other family members earlier – both to provide preventive care through enhanced screenings and to identify existing cancers.”

4. An oral option for targeted therapy

直到最近，PARP抑制剂，主要用于治疗ovarian cancer。They work by preventing damaged cancer cells with specific genetic mutations from repairing themselves. Today, thistargeted therapyis being used to treat breast cancer successfully, too.

“DNA有多种方式来进行自我修复，”利顿解释说。“所以，当一个人拥有这种关闭一个途径的基因突变，它们的DNA用另外一个来代替。PARP抑制剂阻断那些逃生路线，所以癌细胞不能生长和分裂“。

乳腺癌is linked to fewer mutations than ovarian cancers, Litton notes, but PARP inhibitors can still exploit them. Two Phase IIIclinical trials目前正在进行比较t PARP抑制剂o standard-of-care chemotherapy. The OlympiAD trial evaluated olaparib and the EMBRACA trial, led by Litton, evaluated talazoparib. Both trials showed improvements in progression-free survival for patients with an inherited BRCA gene mutation and metastatic breast cancer. Both studies also showed overall improvements in quality of life in patients who received these oral drugs, as opposed to those patients who received chemotherapy.

“It’s fantastic that patients now have an oral option in this class of drugs,” says Litton. “We’re exploring some very promising combinations in clinical trials that try to create a BRCA-like environment for PARP inhibitors to work, even in women who don’t have the targeted mutations. Early results indicate that some patients will still have a complete response: meaning no cancer can be found in their breasts at the time of surgery.”

5.新的药物组合，使雌激素阻断剂更有效

Patients with HR+ — or hormone receptor-positive — breast cancers are often prescribed estrogen-reducing agents such as letrozole and anastrozole to starve the tumors. Now, studies show that those patients do even better when hormone therapy is combined with CDK4/6 inhibitors, which prevent cancer cells from dividing.

“Three different CDK4/6 inhibitors have been approved by the U.S. Food & Drug Administration: abemaciclib, palbociclib and ribociclib,” says Damodaran, a medical oncologist who specializes in breast cancer. “When combined with hormone therapy, all three CDK4/6 inhibitors have shown immense improvement in progression-free survival in patients with stage IV breast cancer. So, this has become the standard of care in nearly all metastatic HR+ breast cancer patients for first-line treatment. It’s a big change in how we treat breast cancer.”

6.下一代的单克隆抗体的

Trastuzimab (Herceptin) is a monoclonal antibody that has been used to treat HER2+ breast cancer patients since the 1990s. It works by targeting the HER2 receptor, preventing cancer growth. Some breast cancers express too much HER2 protein, triggering the cells to multiply very rapidly.

其他单克隆抗体（如pertruzimab / Perjeta），至今已开发。今天，这targeted therapyhas gotten even more advanced. T-DM1 (Kadycla), an antibody-drug combination, has been approved for use in the treatment of HER2+ breast cancers. Antibody-drug combinations work like a “smart bomb,” delivering chemotherapy directly to cancer cells by attaching to their HER2+ receptors.

“靶向治疗已经改变了我们对HER2 +乳腺癌的方法，并提供在某些患者有机会治愈IV期乳腺癌，”达莫达兰说。“所以，单克隆抗体是一个很大的改变游戏规则。”

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