Abstract
Cancer is one of the oldest diseases ever described, since ancient Egypt there have always been attempts to treat and cure this illness. The growing body of knowledge about breast cancer biology and improvements in surgical and medical treatments has been built over time with contributions from many talented and enthusiastic physicians and researchers. Medical advances have changed the approach from a previously incurable condition, into a surgical disease. Further improvements in cancer biology have allowed the development of systemic treatments, hormonal therapies, and targeted drugs. The description of the molecular intrinsic subtypes of breast cancer clarified the understanding of breast cancer as a group of heterogeneous diseases, associated with different clinical outcomes, and therapeutic opportunities. This paper reviews how breast cancer treatment has improved since the earliest descriptions, in ancient times, and how future approaches, such as gene signatures, molecular profiling, and liquid biopsies, aim to further develop individualised treatments and improve treatment outcomes.
Highlights
Monitoring of minimal residual diseaseThe assessment of minimal residual disease is a well-established clinical practice in the management of patients with leukaemia [56], but not in solid tumours; therapeutic decisions in the latter ones are taken on the basis of assessment of the primary tumour and there is no measurable parameter to inform about either response to treatment or occurrence of disease recurrence
The growing body of knowledge about breast cancer biology and improvements in surgical and medical treatments has been built over time with contributions from many talented and enthusiastic physicians and researchers
This paper reviews how breast cancer treatment has improved since the earliest descriptions, in ancient times, and how future approaches, such as gene signatures, molecular profiling, and liquid biopsies, aim to further develop individualised treatments and improve treatment outcomes
Summary
The assessment of minimal residual disease is a well-established clinical practice in the management of patients with leukaemia [56], but not in solid tumours; therapeutic decisions in the latter ones are taken on the basis of assessment of the primary tumour and there is no measurable parameter to inform about either response to treatment or occurrence of disease recurrence. The assessment of either ctDNA or CTCs could be possibly useful for the monitoring of minimal residual disease. 21.5% of the patients were tested positive for CTCs, whereas after chemotherapy this percentage reached 19.6%; there was no correlation of standard clinico-pathologic risk factors and the detection of CTCs. CTCs detection was found to be an independent detrimental prognostic factor, indicating that CTCs could be a measurable parameter assessing minimal residual disease in patients with early-stage breast cancer. A promising implementation of liquid biopsies would be to guide adjuvant treatment selection and monitor its therapeutic effect; such preliminary results have been generated through the assessment of disseminated tumour cells (DTCs) in the bone marrow of patients with early breast cancer [58]
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