Annual Review: Clinical Progress and Future Trends of Breast Cancer

*For medical professionals to read for reference only, experts from the Changjiang Academic Belt Breast Alliance will take you to chase the "hot spots" of breast cancer! At the beginning of 2022, the Yangtze River Breast Cancer Alliance (YBCSG) will join hands with the medical community to open the 2022 New Year's academic show.
Combined with the progress of breast cancer in 2021, the annual inventory and future direction forecast will be conducted, and controversial topics will be discussed to help China Clinical oncologists brought wonderful academic reviews and prospects
.

Professor Zhang Jian, Chairman of YBCSG and Fudan University Affiliated Cancer Hospital, said at the opening of the conference: "I hope that through this New Year's academic show, all colleagues will master the ten annual keywords and perceive the new trends of breast cancer treatment in 2022 in advance; I also look forward to 2022.
The members of YBCSG can produce more academic achievements and occupy the academic high ground
.

" This article draws the essence of the YBCSG New Year's academic show for readers
.

Scan the QR code below to watch the replay of 2021 Breast Cancer Progress: Genetics and Genes of YBCSG Deputy Chairman and Secretary General of YBCSG, Professor Li Hengyu of Shanghai Changhai Hospital, introduced the academic keywords of breast cancer in 2021, and brought the field of breast cancer treatment in 2021 Genetic and genetic research progress, detailed interpretation of the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology and Society of Surgical Oncology hereditary breast cancer management guidelines and the National Comprehensive Cancer Network (NCCN) Genetic/familial high-risk assessment guidelines.
Relevant updates to testing standards
.

Figure 1 Prof.
Li Hengyu analyzed the clinical management strategies of medium-penetrance susceptibility genes, from screening to prevention and treatment, and pointed out future research directions based on new progress
.

At the same time, with the release of the data of the OlympiAD study and the OlympiA study, the value of BRCA gene testing and the application scope and benefit population of PARP inhibitors (PARPi) have been further clarified.

.

The Chinese Anti-Cancer Association guidelines for diagnosis and treatment of breast cancer have also been updated to keep up with the latest developments
.

In terms of multi-gene detection of breast cancer, the population selection for adjuvant chemotherapy after breast cancer surgery was mainly analyzed.
The new results of the RxPONDER study and the MINDACT study further clarified the benefit groups of chemotherapy and endocrine therapy
.

 What kind of vitality can HER2-ADC inject into breast cancer treatment? Vice Chairman of YBCSG and Professor Luo Ting from West China Hospital of Sichuan University deeply interprets the progress of HER2-ADC in the field of breast cancer treatment.
The results of DESTINY-Breast03 study show the significant advantages of DS-8201: a treatment that far exceeds the existing treatment options.
Efficacy and controllable safety - leading the therapeutic leap of ADC drugs, rewriting the treatment landscape for patients with advanced HER2-positive breast cancer
.

At the same time, the recent subgroup analysis results have given new hope to the stable brain metastases in the population with worse prognosis and more difficult treatment
.

Figure 2 In addition to DS-8201, the current research and development of HER2-ADC has shown a trend of "a hundred flowers blooming, a hundred schools of thought contend", and drugs such as ARX778, MRG002, A166, and RC-48 have shown certain therapeutic potential
.

Professor Luo Ting pointed out: "The unique cleavable linker, efficient cytotoxic load and bystander effect of HER2-ADC make ADC therapy broaden the benefit boundary of anti-HER2 therapy and allow more patients with breast cancer with low HER2 expression.
Benefit
.

The recent DAISY study also confirmed that DS-8201 has therapeutic potential in some IHC0+ patients with very low HER2 expression, so we are looking forward to the new breakthroughs brought by ADC in the low HER2 expression population in the future
.

"What is the progress in the treatment of young breast cancer? What is the future trend of chemotherapy with old-fashioned treatment methods? Professor Chen Wenyan, vice chairman of YBCSG and the third hospital of Nanchang City, brought the "Annual Academic Keyword" of the heavy research progress of young breast cancer and explained New trends in chemotherapy are predicted
.

Professor Chen Wenyan's best partner for ovarian function suppression (OFS): aromatase inhibitor (AI) vs tamoxifen (TAM); SOFT&TEXT research data update; young breast cancer age definition controversy ; Interpretation of whether adjuvant chemotherapy can benefit young breast cancer patients with Luminal A one by one
.

Figure 3 At the same time, Professor Chen Wenyan explained the necessity of chemotherapy in BRCA1/2 mutation population, new taxane chemotherapy drugs, chemotherapy drug combination, UTD1 combination The final analysis of the Phase III clinical study of capecitabine, the time and dose of advanced chemotherapy drugs, etc.
were deeply interpreted
.

 The past, present and future of PARPi, Professor Han Xinghua, the vice chairman of YBCSG and the First Affiliated Hospital of the University of Science and Technology of China, gave a speech on the annual academic key The word PARPi made a wonderful summary
.

Professor Han Xinghua pointed out: "Olaparib has been approved by the U.
S.
Food and Drug Administration (FDA) for breast cancer indications, creating a precedent for PARPi in the field of breast cancer treatment
.

"At the same time, the application scope of PARPi has gradually changed from BRCA gene mutation-positive to homologous recombination repair (HRR)-positive
.

Professor Han Xinghua introduced a retrospective study of germline mutations in the homologous recombination repair pathway of multi-cancer species in China
.

Figure 4 From the OlympiAD to OlympiA studies, PARPi has also shown excellent efficacy in the field of early breast cancer
.

Therefore, it is crucial to accurately identify patients with early breast cancer with germline BRCA mutations (gBRCA)
.

At the same time, the applicable population of PARPi adjuvant therapy and whether it is better or worse compared with other therapies are still inconclusive
.

Professor Han Xinghua said that the combination therapy of PARPi may be the future direction of breast cancer development
.

 CDK4/6i gradually changes the treatment pattern of HR+ breast cancer patients.
Professor Li Wei, vice chairman of YBCSG and Jiangsu Provincial People's Hospital, interpreted the frontier progress of CDK4/6 inhibitors (CDK4/6i)
.

CDK4/6i combined with endocrine therapy is one of the treatment options for patients with hormone receptor-positive (HR+) breast cancer
.

Since 2014, the results of PALOMA-1, 2, 3, MONARCH-1, 2, MONALEESA-2, 3 and other studies have been announced, and CDK4/6i has gradually changed the treatment pattern of HR+HER2- advanced breast cancer patients
.

Figure 5 The second-line treatment of CDK4/6i in HR+ and HER2- advanced breast cancer patients also brought survival benefits to the patients
.

The results of PALOMA-3, MONARCH-2, MONALEESA-3, and DWANA-1 studies all support CDK4/6i combined with fulvestrant to effectively prolong progression-free survival (PFS) in patients with HR+ and HER2- advanced breast cancer
.

At present, CDK4/6i has been proved that both first-line and second-line therapy can benefit patients with HR+ and HER2- advanced breast cancer in long-term survival
.

Major guidelines list CDK4/6i combination therapy as the first-line first-line treatment for patients with HR+, HER2- advanced breast cancer
.

 PI3Ki has "showed its prominence", how will the landscape of endocrine therapy change? Deputy Chairman of YBCSG and Professor Liu Shu from the Affiliated Hospital of Guizhou Medical University made an in-depth interpretation of the cutting-edge research related to the annual academic keyword PI3K inhibitor (PI3Ki) and prospected the new trend of endocrine diagnosis and treatment.

.

Professor Liu Shu pointed out that PI3Ki has already "showed its prominence" in reversing resistance to endocrine therapy
.

SOLAR1, BYlieve, BELLE-2, SANDPIPER, POSERIDON and other studies have shown considerable application prospects of PI3Ki, and more data support is expected
.

Figure 6 In terms of new trends in endocrine therapy, Professor Liu Shu said: Late-stage endocrine therapy with a variety of drugs blossomed, and patient survival was prolonged; early adjuvant endocrine therapy gene detection helped precise treatment, and targeting "+" added new evidence; neoadjuvant endocrine therapy It is very important to choose reasonable and effective observation indicators for treatment, and more clinical problems still need to be further solved
.

 The application of immunotherapy in early/late stage TNBC has broad prospects.
Professor Qi Xiaowei, vice chairman of YBCSG and Southwest Hospital of Army Medical University, shared the progress of PD-1/PD-L1 inhibitors in triple-negative breast cancer (TNBC) treatment
.

Four major neoadjuvant immunotherapy studies, IMpassion031 study, KEYNOTE-522 study, GeparNuevo study, and NeoTRIP study, suggest that anthracyclines are still indispensable, and immunocombination chemotherapy is still the dominant treatment mode.
Whether chemotherapy can be "subtracted" still needs more Data support
.

In terms of efficacy predictors, early TNBC neoadjuvant immunotherapy does not depend on factors such as PD-L1 expression and lymph node status, so further exploration of precise biomarkers is still needed
.

Early TNBC adjuvant immunotherapy is also still in progress
.

 Figure 7 In addition to early TNBC, the KETNOTE-355 study provides high-level evidence-based medical evidence for immunotherapy for advanced TNBC patients with positive PD-L1 expression, and more studies on immunotherapy combined with chemotherapy are constantly being explored
.

 TKIs have become one of the "Big Three" in anti-HER2 therapy.
Professor Zheng Yabing, Deputy Chairman of YBCSG and Zhejiang Cancer Hospital, summarized the major progress of tyrosine kinase inhibitors (TKIs) in the field of breast cancer treatment.
Professor Zheng Yabing pointed out that breast cancer target Towards treatment has shifted from the gradual progression of the past to a phase of hand in hand
.

Figure 8 TKI has become a "three-legged" trend with macromolecular monoclonal antibodies and ADC drugs in anti-HER targeted therapy.
Due to its unique mechanism of action, for trastuzumab-treated patients, TKI can exert its advantages to reverse drug resistance
.

At the same time, due to the small molecular weight of TKI, it is easy to penetrate the blood-brain barrier, and has a unique curative effect and high safety for patients with brain metastases
.

The future development trend of TKIs will be to find new indications in neoadjuvant, extended adjuvant therapy, and advanced first-line treatment, and to explore new treatment modes in combination with endocrine drugs in triple-positive breast cancer patients
.

 Combination therapy mode helps patients with brain metastases from breast cancer to survive better YBCSG Deputy Chairman, Professor Xiong Huihua from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, brought a wonderful report on the progress and prospects of breast cancer brain metastases treatment
.

HER2-positive breast cancer with brain metastasis as the first metastatic organ may represent a special biological feature with a relatively poor prognosis
.

Pyrotinib in combination with capecitabine, tucatinib in combination with trastuzumab, and capecitabine can be used as optional treatment options for brain metastases from HER2-positive breast cancer
.

Figure 9 In the context of increased availability of targeted drugs, brain radiotherapy cannot completely replace patients with brain metastases from HER2-positive breast cancer.
In the future, it is necessary to explore the best combination of HER2 ADC drugs and brain radiotherapy.
Brain metastases The treatment of solid tumors is still based on the multidisciplinary consultation (MDT) model
.

Figure 10 Finally, Professor Ye Songqing, Deputy Chairman of YBCSG and Fujian Provincial Hospital concluded: "The times are changing, and the treatment concept is constantly being updated
.

Looking forward to 2022, we look forward to the continuous research and development of more new drugs and more and more clinical basic and translational research data in the future, which will provide more knowledge for clinical decision-making and bring more benefits to patients
.

The breast cancer alliance of the Yangtze River Academic Belt will continue to promote the exchange of breast cancer diagnosis and treatment technologies inside and outside the Yangtze River Basin as its mission, actively carry out multi-center clinical research on breast cancer, promote and improve the technical level of standardized diagnosis and treatment of breast cancer practitioners, and help the growth of young doctors
.

"About the Yangtze River Academic Belt Breast Alliance (YBCSG) The Yangtze River Academic Belt Breast Alliance (YBCSG) is a branch of the Yangtze River Academic Belt Oncology Collaborative Group (YCOG).
Center for clinical research; promote breast cancer professional continuing education, standardize and improve the level of breast cancer practitioners.
YBCSG has
opened
twelve colleges, the College of Breast Surgery and Plastic Surgery, the College of Radiotherapy, the College of Targeting and Immunology, HER2 Home, Support The School of Rehabilitation and Rehabilitation, the School of Diagnosis, the School of Clinical Research, the School of Endocrinology, the School of Genes and Genetics, the School of Chemotherapy, the School of Neoadjuvant Medicine, and the School of Basic and Translational Research have received widespread attention and praise
.

At present, Professor Zhang Jian of Fudan University Affiliated Cancer Hospital serves as the director of YBCSG Members, Professor Li Hengyu of the First Affiliated Hospital of Naval Military Medical University serves as the deputy director and secretary general of YBCSG, Professor Li Wei, Professor Zheng Yabing, Professor Ye Songqing, Professor Han Xinghua, Professor Chen Wenyan, Professor Xiong Huihua, Professor Wang Shouman, Professor Qi Xiaowei from all provinces and cities in the alliance , Prof.
Luo Ting, Prof.
Nie Jianyun, Prof.
Liu Shu as vice chairmen
.

Focus on the doctor's side, pay attention to the patient's side About the medical community media ("Medical World") "Medical World" is China's leading new medical media and doctor service platform, with " With the purpose of serving doctors and improving medical care", it provides professional, timely and reliable content to medical workers.
At present, it has more than 20 WeChat subscription accounts for clinical specialties, such as the Medical Oncology Channel, the Medical Blood Channel, and the Medical Cancer Friends Association.
10 million user subscriptions
.

The "Medical Doctor Station APP" launched by the "Medical World" mainly provides medical information, expert live broadcasts, clinical courses, examination question banks and other high-quality content for doctors.
More than 2.
5 million registered users
.

>>>> A small survey on family doctors (if you are a family doctor, please answer the following 5 questions) Source: Medical Oncology Channel Review: Changjiang Academic Belt Breast Alliance Editor in charge: Zheng Huaju Proofreading: Zang Hengjia Plate making: Xue Jiao Past issues Wonderful review of Dr.
Zhu Bin: Authoritative release after leaving Xiehe! The 2022 edition of the "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer" is coming to a New Year's public speech: listening to doctors talk about "The Shimmer of Life"* The medical community strives to be accurate and reliable when the published content is approved, but it does not care about the timeliness of the published content.
and the accuracy and completeness of the cited information (if any), and does not assume any responsibility for the outdated content, possible inaccuracy or incompleteness of the cited information,
etc.

Relevant parties are requested to check separately when adopting or using it as a basis for decision-making
.