Recent advances in breast cancer research are offering new hope to patients around the world. Scientists have developed innovative treatments and diagnostic tools that promise to significantly improve survival rates and quality of life for those affected by this disease.
Along these lines, during the last GEICAM Annual Review of advances in Breast Cancer (RAGMA) a multitude of new data on this disease and new approaches were presented. This meeting brings together all professionals related to breast cancer and carries out an exhaustive review of the advances in research, diagnosis and treatment of this disease.
As explained to Gaceta Médica José Enrique Alés Martínez, oncologist at the Ávila Healthcare Complex and scientific coordinator of RAGMA 2024, “the objective of this event is independent updating, interdisciplinary updating and being a meeting place for all professionals who treat breast cancer.” Thus, the specialist highlights that in this edition the focus has been on “the use of artificial intelligence in prevention/early diagnosis of breast cancer, on the use of more effective surgeries with less aggressiveness and on new drugs.” .
Significant advances
Throughout the event, various studies and advances of various kinds in breast cancer were presented, although, as Alés points out, “all the news is important.” Some of the Smaller advances can have a big impact, as the Ávila Complex specialist explains, “for example, the possibility of determining the presence of the FOXC1 protein in the biopsy through a simple immunohistochemistry test; “Which patients really benefit from capecitabine within the triple negative population (GEICAM-CIBOMA study) or how a simple determination in an analysis allows us to know which women are really menopausal and can benefit more from endocrine treatment.”
In addition, Ricardo Sánchez-Escribano Morcuende, member of the RAGMA 2024 organizing committee and oncologist at the Valladolid University Clinical Hospitalpoints out to this medium that “the presentation by Alexis Barr, a researcher at Imperial College London, would be especially highlighted, who presented the mechanisms of entry and exit of the tumor cell from replicative to quiescent states that explain latency and late relapses (years after be treated with curative intent) that we observe in our patients.”
In many cases, prolonged treatment with hormone therapy and CDK4/6 inhibitors causes a permanent exit from the cell cycle, the so-called senescence, and tumor regression in which the cells increase in size, but do not proliferate and are finally eliminated. This process can be monitored in vivo through the levels of the p21 protein, which could become a biomarker of therapeutic activity.
Less invasive approaches
The advances and developments in different interventions, as “surgical techniques that make it possible to eliminate the need for sentinel lymph nodes in a selected population of patients. Even, although still under investigation, the possibility of performing percutaneous cryoablation in some cases with only local anesthesia,” adds Alés.
Another of the key points that were addressed was de-escalation of axillary surgery “which can be safely omitted in an increasing number of patients, reducing morbidities and improving quality of life,” Sánchez-Escribano specifies. “This trend began with the American ACOSOG Z11 study and later with the European SINODAR and SOUND studies. The results of this last study, which allows axillary surgery to be safely omitted in patients with small tumors and a negative ultrasound, were reported by its first author, Oreste Gentilini of the San Raffaelle Institute of Milan, in the latest edition of RAGMA.”
In another line of research, specialist Alés also highlights the new way of administering chemotherapy “through the use of targeted monoclonal antibodies to specific antigens that must be overrepresented in tumor tissue. The idea is to achieve more efficacy and less general toxicity.” However, this ideal is still not achieved in a perfect way, the number of these agents continues to increase. “The latest in breast cancer research are sacituzumab govitecan, enfortumab vedotin, sacituzumab tirumotecan or datopotamab deruxtecan, all of them in different indications,” clarifies the specialist from the Ávila Complex.
Advances in AI and genetics
The field of artificial intelligence (AI) is having a significant impact in terms of the diagnosis of numerous diseases and breast cancer is no exception. As oncologist Sánchez-Escribano points out, “the most advanced line of development of AI in breast cancer and closest to its use is based on its application in evaluation of screening mammograms where there are already tools in clinical use demonstrating greater detection capacity, reducing the incidence of interval tumors and allowing better characterization of dense breast to allow personalized screening programs.” In this sense, it is worth highlighting the findings reported by Solveig Hofvind, head of the Norwegian screening program where a pilot study with an AI system is being carried out.
“The most advanced line of development of AI in breast cancer and close to its use is based on its application in the evaluation of screening mammograms where tools already exist in clinical use”
Ricardo Sánchez-Escribano Morcuendeoncologist at the University Clinical Hospital of Valladolid and coordinator of RAGMA 2024
In another line of advances, genetic susceptibility is represented in a significant number of investigations. “Perhaps the most important thing is the growth in the number of patients and carriers included in the databases, as well as the studies that determine the polygenic risk score,” says Alés. “These are genes that contribute less strongly to the risk of breast cancer than those traditionally associated with familial breast cancer. However, thanks to exhaustive studies of genomic variants in increasingly larger populations, it has been possible to elucidate associations between various combinations of these variants and the risk of breast cancer,” details the expert. These advances help on the path of personal quantification of breast cancer riskwhich could allow personalization of screening tests.
Treatment resistance
The problem of resistance to drugs and other treatments is very complex and goes beyond infections. In the case of breast cancer, “various studies published or presented during the last year address the problem of resistance to antineoplastic drugs and new ways to overcome them. One of the most notable works was the INAVO120 study, which addresses one of those recognized resistance pathways to hormonal therapy in patients with advanced luminal tumors – HER2 -: the mutation of the PI3KCA gene. This study, presented at the 2023 San Antonio Congress, demonstrated an improvement in the progression-free survival of patients by 57 percent, by associating a PI3K inhibitor (inavolisib) with the standard therapy consisting of hormone therapy (fulvestrant) and an inhibitor. of CDK4/6 (palbociclib).
Along these lines, Alés highlights that “there are various ways to address it, although until now there are no ways to reverse this resistance in itself, but instead we resort to changing the treatment for another that has a different mechanism of action. Progress is being made, at the research level, in the earlier identification of these resistances in order to be able to address them earlier, but it remains a long way to go in this field”.
You may also like…