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Genetics and Oncology (part 2.). Fundamentals of personalised medicine in the treatment of breast and ovarian cancer
Affiliations- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland
- Wrocław Comprehensive Cancer Centre, Wrocław, Poland
- Department of Oncology, Wrocław Medical University, Wrocław, Poland
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Abstract
Individualisation of medical management based on prognostic and predictive markers (personalised medicine) allows customisation of prophylaxis and optimisation of treatment by increasing its efficiency and minimisation of adverse effects. In the case of breast cancer, therapy selection is still based on histopathology and immunohistochemical assessment including analysis of estrogen receptor (ER) expression, progesterone receptor (PgR) expression and over-expression or amplification of receptor tyrosine kinase erbB-2 gene (ERBB2 aka HER2). An additional role, facilitating decision on application or waiver of chemotherapy in early breast cancer, may be played by panels assessing gene expression within tDNA (tumour DNA, i.e. DNA isolated from tumour cells) and evaluation of concentration of uPA (urokinase-type plasminogen activator) and PAI-1 (plasminogen activator inhibitor type 1) in tumour cells. Growing hope surrounds the new, targeted therapies, including: inhibitors of CDK 4/6 (cyclin-dependant kinases 4 and 6), mTOR inhibitors (rapamycin’s mammalian target), inhibitors of poly(ADP-ribose)polymerase(PARP) or inhibitors of PI3K (phosphatidylinositol-4,5-bisphosphate 3-kinases). For ovarian cancer, treatment selection is based on assessment of the histopathologic type, malignancy degree, FIGO classification and platinum sensitivity of the tumour. However, the increasing use of PARP inhibitors and angiogenesis inhibitors is noteworthy. In the context of personalised medicine for both these cancers, an important element involves also individualisation of prophylactic and therapeutic recommendations in carriers of germline mutations associated with hereditary cancer syndromes.
Abstract
Individualisation of medical management based on prognostic and predictive markers (personalised medicine) allows customisation of prophylaxis and optimisation of treatment by increasing its efficiency and minimisation of adverse effects. In the case of breast cancer, therapy selection is still based on histopathology and immunohistochemical assessment including analysis of estrogen receptor (ER) expression, progesterone receptor (PgR) expression and over-expression or amplification of receptor tyrosine kinase erbB-2 gene (ERBB2 aka HER2). An additional role, facilitating decision on application or waiver of chemotherapy in early breast cancer, may be played by panels assessing gene expression within tDNA (tumour DNA, i.e. DNA isolated from tumour cells) and evaluation of concentration of uPA (urokinase-type plasminogen activator) and PAI-1 (plasminogen activator inhibitor type 1) in tumour cells. Growing hope surrounds the new, targeted therapies, including: inhibitors of CDK 4/6 (cyclin-dependant kinases 4 and 6), mTOR inhibitors (rapamycin’s mammalian target), inhibitors of poly(ADP-ribose)polymerase(PARP) or inhibitors of PI3K (phosphatidylinositol-4,5-bisphosphate 3-kinases). For ovarian cancer, treatment selection is based on assessment of the histopathologic type, malignancy degree, FIGO classification and platinum sensitivity of the tumour. However, the increasing use of PARP inhibitors and angiogenesis inhibitors is noteworthy. In the context of personalised medicine for both these cancers, an important element involves also individualisation of prophylactic and therapeutic recommendations in carriers of germline mutations associated with hereditary cancer syndromes.
Keywords
personalised medicine; breast cancer; ovarian cancer; predictive tests; prognostic tests; germline mutations
About this articleTitle
Genetics and Oncology (part 2.). Fundamentals of personalised medicine in the treatment of breast and ovarian cancer
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
187-202
Published online
2020-10-05
Page views
855
Article views/downloads
765
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2020;70(5):187-202.
Keywords
personalised medicine
breast cancer
ovarian cancer
predictive tests
prognostic tests
germline mutations
Authors
Anna Doraczyńska-Kowalik
Gabriela Janus-Szymańska
Rafał Matkowski
Dagmara Michałowska
Maria M. Sąsiadek
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