4.8 Review

Deciphering breast cancer: from biology to the clinic

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Targeting HER2-positive breast cancer: advances and future directions

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Summary: The discovery of the monoclonal antibody trastuzumab almost 25 years ago revolutionized treatment and drug development for HER2(+) breast cancer. Here, Swain et al. review the current standard of care for HER2(+) breast cancer, describe mechanisms of drug resistance, and focus on next-generation platforms and therapies for the treatment of this disease.

NATURE REVIEWS DRUG DISCOVERY (2023)

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Prognostic and Predictive Value of Immune-Related Gene Expression Signatures vs Tumor-Infiltrating Lymphocytes in Early-Stage ERBB2/HER2-Positive Breast Cancer: A Correlative Analysis of the CALGB 40601 and PAMELA Trials

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Summary: Assessment of tumor-infiltrating lymphocytes (TILs) and immune-related gene expression signatures can predict better treatment outcomes in patients with early-stage ERBB2/HER2-positive breast cancer. However, the combined prognostic value of these immune activation measures is not known.

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Multi-omic machine learning predictor of breast cancer therapy response

Stephen-John Sammut et al.

Summary: This study demonstrates that the response to breast cancer treatment is influenced by the pre-treatment tumour ecosystem, and a machine learning model incorporating multi-omic features can predict pathological complete response.

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Article Medicine, General & Internal

Event-free Survival with Pembrolizumab in Early Triple-Negative Breast Cancer

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Summary: The addition of pembrolizumab to neoadjuvant chemotherapy followed by adjuvant pembrolizumab after surgery significantly prolonged event-free survival in patients with early triple-negative breast cancer.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

Review Oncology

Clinical Review on the Management of Hormone Receptor-Positive Metastatic Breast Cancer

Nicholas P. McAndrew et al.

Summary: The natural history of hormone receptor-positive breast cancer is more favorable than other subtypes. Traditional endocrine therapy and molecularly targeted agents have improved outcomes. Treatment plans should take multiple factors into account.

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Article Oncology

Identification of the JNK-Active Triple-Negative Breast Cancer Cluster Associated With an Immunosuppressive Tumor Microenvironment

Takashi Semba et al.

Summary: The study identified that high phosphorylated JNK level in TNBC is associated with increased Treg infiltration. Inhibition of JNK signaling led to reduced tumor growth and Treg infiltration, and increased CD8(+) T cell infiltration, possibly through suppression of CCL2 secretion. This suggests that targeting the JNK/C-JUN/CCL2 axis may offer new therapeutic strategies for combating the aggressiveness of TNBC.

JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE (2022)

Article Oncology

Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer: ASCO Guideline Update

Fabrice Andre et al.

Summary: This article provides updated recommendations on the appropriate use of breast cancer biomarker assay results in guiding adjuvant endocrine and chemotherapy decisions for early-stage breast cancer. Based on the latest literature and expert consensus, specific biomarker assay results can be used to guide treatment decisions for patients who meet certain criteria. However, other factors such as disease stage, comorbidities, and patient preferences should also be considered.

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Breast tumor microenvironment structures are associated with genomic features and clinical outcome

Esther Danenberg et al.

Summary: Imaging mass cytometry profiling of 693 breast tumors revealed 10 recurrent tumor microenvironment spatial structures, associated with genomic profiles and outcomes. These multicellular structures within the TME, varying in vascular content, stromal activation, and leukocyte composition, could improve patient stratification and link spatial organization to local TME function.

NATURE GENETICS (2022)

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Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer

J. Cortes et al.

Summary: Among patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane, trastuzumab deruxtecan was associated with a lower risk of disease progression or death compared to trastuzumab emtansine. However, treatment with trastuzumab deruxtecan was associated with interstitial lung disease and pneumonitis.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

Article Oncology

Fulvestrant plus capivasertib versus placebo after relapse or progression on an aromatase inhibitor in metastatic, oestrogen receptor-positive, HER2-negative breast cancer (FAKTION): overall survival, updated progression-free survival, and expanded biomarker analysis from a randomised, phase 2 trial

Sacha J. Howell et al.

Summary: This study demonstrates that the addition of Capivasertib to fulvestrant improves progression-free survival and overall survival in women with aromatase inhibitor-resistant advanced breast cancer. The expanded genetic testing panel suggests that Capivasertib predominantly benefits patients with alterations in the PI3K/AKT/PTEN pathway.

LANCET ONCOLOGY (2022)

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cGAS-STING drives the IL-6-dependent survival of chromosomally instable cancers

Christy Hong et al.

Summary: Chromosomal instability (CIN) drives cancer cell evolution, metastasis, and therapy resistance. This study reveals that the inactivation of cGAS-STING signaling selectively impairs the survival of triple-negative breast cancer cells with CIN. Furthermore, blockade of IL-6 signaling using tocilizumab selectively impairs the growth of triple-negative breast cancer cells with CIN.

NATURE (2022)

Article Multidisciplinary Sciences

Truncated FGFR2 is a clinically actionable oncogene in multiple cancers

Daniel Zingg et al.

Summary: The truncation of exon 18 of Fgfr2 is identified as a potent driver mutation, while FGFR2 full-length amplifications require cooperation with other driver genes. Therefore, tumors with FGFR2 variants involving truncated E18 should be considered for FGFR-targeted therapies.

NATURE (2022)

Article Medicine, General & Internal

Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer

Shanu Modi et al.

Summary: Trastuzumab deruxtecan demonstrated significantly longer progression-free and overall survival compared to physician's choice chemotherapy in patients with HER2-low metastatic breast cancer.

NEW ENGLAND JOURNAL OF MEDICINE (2022)

Article Oncology

Sacituzumab Govitecan in Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer

Hope S. Rugo et al.

Summary: The study demonstrates the potential of Sacituzumab govitecan in the treatment of breast cancer, with a longer progression-free survival compared to traditional chemotherapy regimens and a manageable safety profile.

JOURNAL OF CLINICAL ONCOLOGY (2022)

Article Oncology

Switch to fulvestrant and palbociclib versus no switch in advanced breast cancer with rising ESR1 mutation during aromatase inhibitor and palbociclib therapy (PADA-1) a randomised, open-label, multicentre, phase 3 trial

Francois-Clement Bidard et al.

Summary: The PADA-1 trial aimed to show the efficacy of early therapeutic targeting of rising ESR₁ mutation in blood (bESR₁(mut)), while assessing the safety of combination fulvestrant and palbociclib. Results demonstrated that early therapeutic targeting of bESR₁(mut) resulted in significant clinical benefit.

LANCET ONCOLOGY (2022)

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Targeted immunotherapy against distinct cancer-associated fibroblasts overcomes treatment resistance in refractory HER2+breast tumors

Elisa Rivas et al.

Summary: This study identifies a population of cancer-associated fibroblasts that are involved in suppressing the effectiveness of trastuzumab-induced ADCC in HER2+ breast cancer patients who do not respond to HER2-targeted therapy. The presence of this cellular subset, activated by TGF-beta, is related to low IL2 activity in the tumor microenvironment. Stimulation of the IL2 pathway in the tumor stroma restores the anti-cancer efficiency of trastuzumab in unresponsive tumors.

NATURE COMMUNICATIONS (2022)

Review Oncology

Targeting CDK4 and CDK6 in cancer

Shom Goel et al.

Summary: Dysregulation of CDK4 and CDK6 promotes the growth and survival of several cancer types. CDK4/6 inhibitors have become the standard of care for advanced hormone receptor-positive breast cancer. Better understanding of their mechanisms of action and exploring new therapeutic opportunities are crucial.

NATURE REVIEWS CANCER (2022)

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Multi-omic machine learning predictor of breast cancer therapy response

Stephen-John Sammut et al.

Summary: The response to therapy in breast cancers is influenced by the pre-treated tumour ecosystem, and predictive models integrating multi-omics features through machine learning can be used to predict treatment outcomes. The degree of residual disease following therapy is monotonically associated with pre-therapy features of the tumour.

NATURE (2022)

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Single-cell analyses reveal key immune cell subsets associated with response to PD-L1 blockade in triple-negative breast cancer

Yuanyuan Zhang et al.

Summary: The study indicates that high levels of baseline CXCL13(+) T cells are associated with effective responses to combination therapy in triple-negative breast cancer patients. These cells increase following combination therapy but decrease after monotherapy, highlighting their importance in predicting treatment outcomes.

CANCER CELL (2021)

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The androgen receptor is a tumor suppressor in estrogen receptor-positive breast cancer

Theresa E. Hickey et al.

Summary: Studies have shown that androgen receptor (AR) plays a tumor suppressor role in estrogen receptor (ER)-positive breast cancer, with AR activation helping to suppress cell cycle genes and promote the expression of tumor suppressor genes, enhancing therapeutic responses.

NATURE MEDICINE (2021)

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A Population-Based Study of Genes Previously Implicated in Breast Cancer

Chunling Hu et al.

Summary: This study provides population-based estimates of the prevalence and risk of breast cancer associated with pathogenic variants in known cancer-predisposition genes. The results highlight the varying levels of risk associated with different genes, such as high risk for BRCA1 and BRCA2 and moderate risk for PALB2, as well as associations with specific subtypes of breast cancer for genes like RAD51C and RAD51D.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

Hyuna Sung et al.

Summary: The global cancer burden in 2020 saw an estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths. Female breast cancer surpassed lung cancer as the most commonly diagnosed cancer, while lung cancer remained the leading cause of cancer death. These trends are expected to rise in 2040, with transitioning countries experiencing a larger increase compared to transitioned countries due to demographic changes and risk factors associated with globalization and a growing economy. Efforts to improve cancer prevention measures and provision of cancer care in transitioning countries will be crucial for global cancer control.

CA-A CANCER JOURNAL FOR CLINICIANS (2021)

Article Medicine, General & Internal

21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer

Kevin Kalinsky et al.

Summary: The study showed that among premenopausal women with hormone-receptor-positive, HER2-negative breast cancer and one to three positive lymph nodes with a recurrence score of 25 or lower, the addition of chemotherapy to endocrine therapy led to longer invasive disease-free survival and distant relapse-free survival compared to endocrine therapy alone. However, postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy in terms of invasive disease-free survival.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

Article Oncology

70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age

Martine Piccart et al.

Summary: The MINDACT trial demonstrated that patients with breast cancer of high clinical and low genomic risk who did not receive chemotherapy had excellent 5-year distant metastasis-free survival. The long-term follow-up results, including exploratory analysis by age, further support the use of genomic testing in identifying patients who can forgo chemotherapy. Chemotherapy showed different effects on distant metastasis-free survival based on age and nodal status, especially in hormone receptor-positive, HER2-negative disease.

LANCET ONCOLOGY (2021)

Article Multidisciplinary Sciences

Spatial deconvolution of HER2-positive breast cancer delineates tumor-associated cell type interactions

Alma Andersson et al.

Summary: This study utilized Spatial Transcriptomics technology to investigate gene expression in HER2-positive breast tumors, identifying shared gene signatures for immune and tumor processes and developing a predictive model for cellular interactions.

NATURE COMMUNICATIONS (2021)

Article Biochemistry & Molecular Biology

A single-cell RNA expression atlas of normal, preneoplastic and tumorigenic states in the human breast

Bhupinder Pal et al.

Summary: Global changes in breast heterogeneity were examined across different states through single-cell transcriptome analysis, revealing notable variations in the stroma of post-menopausal women and a discrete subset of cycling cells in tumor samples. Comparison between preneoplastic BRCA1(+/-) tissue and tumors highlighted global changes in the immune microenvironment. Proliferative CD8(+) T cells were found to characterize certain breast cancer subtypes, suggesting potential differences in immunotherapy targets.

EMBO JOURNAL (2021)

Article Multidisciplinary Sciences

Breast tumours maintain a reservoir of subclonal diversity during expansion

Darlan C. Minussi et al.

Summary: Breast tumors and cell lines consist of numerous subclones organized into a few major superclones. Following clonal TP53 mutations, loss-of-heterozygosity events, and genome doubling, primary tumors undergo a period of transient genomic instability, with ongoing copy number evolution during expansion. Subcloned daughter cells demonstrate genomic rediversification, showing that triple-negative breast cancers continually evolve chromosome aberrations and maintain subclonal diversity during primary tumor growth.

NATURE (2021)

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A single-cell map of intratumoral changes during anti-PD1 treatment of patients with breast cancer

Ayse Bassez et al.

Summary: The study found that in breast cancer patients, anti-PD1 treatment can lead to clonal expansion of PD1-expressing T cells in a subset of tumors, regardless of tumor subtype. The expansion mainly involves CD8(+) T cells and CD4(+) T cells with distinct immune cell characteristics.

NATURE MEDICINE (2021)

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Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer

A. Bardia et al.

Summary: Patients with metastatic triple-negative breast cancer treated with Sacituzumab govitecan had significantly longer progression-free and overall survival compared to standard chemotherapy, but experienced more frequent myelosuppression and diarrhea as adverse events.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Genomic profile of advanced breast cancer in circulating tumour DNA

Belinda Kingston et al.

Summary: Genomic profiling of advanced breast cancer using plasma circulating tumour DNA sequencing revealed diverse subclonal resistance mutations, with distinct mutational processes identified in ER-positive breast cancer. This study highlights the importance of subclonal diversification in pre-treated advanced breast cancer, presenting novel therapeutic opportunities.

NATURE COMMUNICATIONS (2021)

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Metabolic modulation by CDK4/6 inhibitor promotes chemokine-mediated recruitment of T cells into mammary tumors

Roman Uzhachenko et al.

Summary: Inhibitors of cyclin-dependent kinases 4 and 6 (CDK4/6i) delay metastatic breast cancer progression, while also enhancing the efficacy of T cell-based therapies by inducing chemokines that recruit activated CD8(+) T cells to the tumor. The metabolic stress induced by CDK4/6i treatment in breast cancer cells plays a key role in this process, suggesting a link between tumor metabolic vulnerabilities and anti-tumor immunity.

CELL REPORTS (2021)

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A single-cell and spatially resolved atlas of human breast cancers

Sunny Z. Wu et al.

Summary: This study presents a comprehensive transcriptional atlas of the cellular architecture of breast cancer, identifying recurrent neoplastic cell heterogeneity and new immune cell populations associated with clinical outcomes. A multi-omic atlas integrates single-cell RNA sequencing, spatial transcriptomics, and immunophenotyping to stratify breast cancer into nine ecotypes with unique cellular compositions and clinical outcomes.

NATURE GENETICS (2021)

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Adjuvant Olaparib for Patients with BRCA1- or BRCA2-Mutated Breast Cancer

Andrew N. J. Tutt et al.

Summary: In patients with high-risk, HER2-negative early breast cancer and germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants, adjuvant olaparib after completion of local treatment and neoadjuvant or adjuvant chemotherapy was associated with significantly longer survival free of invasive or distant disease than placebo. Olaparib had limited effects on global patient-reported quality of life.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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RNF2 ablation reprograms the tumor-immune microenvironment and stimulates durable NK and CD4+ T-cell-dependent antitumor immunity

Zhuo Zhang et al.

Summary: The study identified tumoral ring finger protein 2 as a negative regulator of antitumor immunity in various human cancers, deletion of related genes can induce durable tumor rejection and establish immune memory.

NATURE CANCER (2021)

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Serial single-cell genomics reveals convergent subclonal evolution of resistance as patients with early-stage breast cancer progress on endocrine plus CDK4/6 therapy

Jason I. Griffiths et al.

Summary: The study reveals that early-stage estrogen receptor-positive breast cancer patients receiving combination cyclin-dependent kinase inhibitors and endocrine therapy develop resistance through a shift from estrogen to alternative growth signal-mediated proliferation, with convergent clonal evolution mechanisms identified.

NATURE CANCER (2021)

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Peter J. Campbell et al.

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Hartland W. Jackson et al.

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Paolo Tarantino et al.

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Harold J. Burstein

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Oscar M. Rueda et al.

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Aberrant FGFR signaling mediates resistance to CDK4/6 inhibitors in ER plus breast cancer

Luigi Formisano et al.

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Francois Bertucci et al.

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Fabrice Andre et al.

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Joseph A. Sparano et al.

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Association analysis identifies 65 new breast cancer risk loci

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Class IIa HDAC inhibition reduces breast tumours and metastases through anti-tumour macrophages

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The genomic and transcriptomic architecture of 2,000 breast tumours reveals novel subgroups

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Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies

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