Abstract
Breast cancer has become one of the biggest concerns for oncologists in the past few decades because of its unpredictable etiopathology and nonavailability of personalized translational medicine. The number of women getting affected by breast cancer has increased dramatically, owing to lifestyle and environmental changes. Besides, the development of multidrug resistance has become a challenge in the therapeutic management of breast cancer. Studies reveal that the use of monotherapy is not effective in the management of breast cancer due to high toxicity and the development of resistance. Combination therapies, such as radiation therapy with adjuvant therapy, endocrine therapy with chemotherapy, and targeted therapy with immunotherapy, are found to be effective. Thus, multimodal and combination treatments, along with nanomedicine, have emerged as a promising strategy with minimum side effects and drug resistance. In this review, we emphasize the multimodal approaches and recent advancements in breast cancer treatment modalities, giving importance to the current data on clinical trials. The novel treatment approach by targeted therapy, according to type, such as luminal, HER2 positive, and triple-negative breast cancer, are discussed. Further, passive and active targeting technologies, including nanoparticles, bioconjugate systems, stimuli-responsive, and nucleic acid delivery systems, including siRNA and aptamer, are explained. The recent research exploring the role of nanomedicine in combination therapy and the possible use of artificial intelligence in breast cancer therapy is also discussed herein. The complexity and dynamism of disease changes require the constant upgrading of knowledge, and innovation is essential for future drug development for treating breast cancer.
Highlights
Breast cancer (BC) is one of the most common cancers prevalent across the globe and is one of the leading causes of mortality and morbidity in women [1]
There are different drugs available for the treatment, namely, lapatinib, a tyrosine kinase receptor inhibitor that interrupts both human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR), and microtubule inhibitors linked with antibody cytotoxic agents, e.g., emtansine linked with the monoclonal antibody trastuzumab [4]
A Phase 1/2 dose-escalation study of XL147 (SAR245408), or XL765 (SAR245409) in combination with letrozole performed on subjects with hormone receptor-positive and HER2-negative breast cancer refractory to a nonsteroidal aromatase inhibitor To study the efficacy of a combination of pilaralisib with trastuzumab or paclitaxel and trastuzumab in patients with metastatic -BC To assess the safety and efficacy in men and postmenopausal women patients with advanced-BC
Summary
Breast cancer (BC) is one of the most common cancers prevalent across the globe and is one of the leading causes of mortality and morbidity in women [1]. Molecular subtyping of breast cancer explains its four types of nature, namely, luminal breast cancer (LBC) type A, LBC type B, human epidermal growth factor receptor 2 (HER2) positive breast cancer, and triple-negative breast cancer (TNBC) [4]. In the case of type-B, both HR and HER tests are positive In addition to these two types, BC shows a high amount of Ki-67 expression. Based on various factors such as cancer stage, presence/absence of hormone receptors, genetic and epigenetic alterations, and biomarkers, different treatment strategies are adopted. Such strategies include surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy, targeted therapy used alone or in combination. The recent research related to the utilization of nanotechnological platforms to deliver drugs effectively is included in the second part of this review
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