Can We Predict Best Treatment – Tailored Approach To Breast Cancer Treatment
Breast cancer is the most common cancer in women worldwide and in Indian metro cities. Breast cancer is basically a disease of hormonal imbalance , longer and higher the estrogen exposure it increase chances of breast cancer.
Biology of every cancer patient is different and some patients behave very aggressively and even most aggressive form of treatment can not cure them and some very slow growing and even a simple hormonal treatment give them a long life.
Previously in 1950s the treatment was same for every lady sufferring from breast cancer and radical mastectomy and radiotherapy was treatment to every patient.During that time Dr Bernard fischer undertook many scintific clinical trials and proved many things and treatment became better and conservation of breast concept came. He proved that if a lady receive chemotherapy in adjuvant setting doing breast coservation surgery does not affect her survival. Survival is same for a lady undergoing Radical surgery versus Breast conservation surgery if she receive adjuvant chemotherapy.
In further studies size of primary tumor and no of involved axillary lymph node decided the chemotherapy agents to be given.
Then hormonal treatment came into existence and every lady was also given hormonal treatment. Identification of Estrogen and Progesterone receptor on tumor cells started deciding which lady need hormonal treatment , if ER &/or PgR was positive in tumor cells hormonal treatment was beneficial.
Another target in form of HER-2-neu was identified and a targeted drug against this in form of TRASTUZUMAB was used initially in metastatic breast cancer and now in now in adjuvant treatment of breast cancer if tumor cells are positive for HER-2_neu and survival becomes better.
In last 50 years we have understood the biology of breast cancer and molecular markers which can predict the chance of relapse and treatment to be given to an individual patient so everyu patient has a particular molecular signature in their genes and this gene profile of patients can be detected on tumor blocks and we can advise the best treatment for individual patient with best survival with least toxicity of drugs.
There are many things which decide the treatment of individual patient- tumor size, number of axillary nodes involved, lymphovascular and perineural invasion, ER, PgR status, HER-2-neu status, adjuvant score, gene profile (molecular signature) are taken into consideration for deciding the treatment of a patient and every patient gets a different treatment as per her profile.