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Breast cancer assessment tools and optimizing adjuvant therapy

Nature Reviews Clinical Oncology volume 7, pages 725–732 (2010)Cite this article

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Abstract

Recommendation of systemic adjuvant therapy and choice of optimal agents for early-stage breast cancer remains a challenge. Adjuvant therapy is indicated on the assumption of residual micrometastatic disease. Adjuvant assessment tools for prognosis and prediction of treatment benefit, including Adjuvant! Online, the St Gallen Consensus, Oncotype DX® and MammaPrint®, aid clinical decision making. However, all of these tools have limitations that must be considered in their judicious application. Clinicopathological based tools are critically dependent on accurate, standardized measurement of parameters. Multigene tools are appealing for their objectivity and reproducibility, particularly regarding analysis of proliferation, but these approaches still overlook the biological heterogeneity within tumors evidenced by distinct cell subpopulations with different genomic patterns and function. The greatest treatment challenge remains for patients assessed as intermediate risk of relapse, a problem not overcome by multigene tools. Remarkable diversity in breast cancer dictates that adjuvant management must be biologically driven. Future identification of predictive biomarkers for specific chemotherapy sensitivity may allow targeted use of available agents, including anthracyclines, taxanes and DNA damaging agents. The presence of drug targets and targetable signaling pathways, rather than molecularly defined subgroups, may ultimately drive treatment decisions.

Key Points

  • Early breast cancer assessment tools for prognosis and prediction of treatment benefit may aid clinical decision making; however, their limitations must be considered

  • Adjuvant! Online and the St Gallen Consensus incorporate discriminating clinicopathological factors; critical to these guidelines is accurate, standardized measurement of pathological parameters

  • Multigene signatures, Oncotype DX® and MammaPrint®, offer objective, reproducible analysis, particularly of proliferation but it remains to be seen whether they are more beneficial than accurate, standardized clinicopathological assessment

  • The greatest treatment challenge remains for patients assessed as intermediate risk of relapse

  • Breast cancers show remarkable diversity in biology and treatment efficacy; optimal management must be biologically driven and predictive biomarkers may guide use of systemic therapy

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Authors and Affiliations

  1. Department of Oncology, Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Istituto Toscano Tumori, Piazza Ospedale 2, Prato, 59100, Italy

    Catherine Oakman & Angelo Di Leo

  2. Department of Oncology, Translational Research Unit, Hospital of Prato, Istituto Toscano Tumori, Piazza Ospedale 2, Prato, 59100, Italy

    Libero Santarpia

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  1. Catherine Oakman
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  2. Libero Santarpia
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L. Santarpia contributed to researching the data for this article and review/editing of the manuscript. A. Di Leo and C. Oakman contributed equally to researching the data for this article, the discussion, writing, and review/editing of the manuscript.

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Correspondence to Angelo Di Leo.

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Oakman, C., Santarpia, L. & Di Leo, A. Breast cancer assessment tools and optimizing adjuvant therapy. Nat Rev Clin Oncol 7, 725–732 (2010). https://doi.org/10.1038/nrclinonc.2010.170

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