Breast cancer may be one of the cancer types with the most treatments at present. In the six-person ward, there are all patients in the middle and late stages. Some are receiving chemotherapy, some are receiving radiotherapy, some are waiting for surgery, some are receiving hormone therapy, and some are receiving targeted therapy, immunotherapy .
- "Why is my treatment method like this? Is it just a matter of money and personal choice?" I believe many people want to ask. After all, before being diagnosed with breast cancer, many people even think that there is only one type of breast cancer, divided into early, middle and late stages. So today we will talk about the "classification" of breast cancer that determines treatment methods in . Let me take you through the main treatments for breast cancer and their basis.
- Why do we need to understand the classification of tumors?
Many people believe that cancer must be classified first and then corresponding drugs and treatments. In fact, the classification of many cancers is closely related to the treatment plan. It is likely that the drugs and treatments are determined, and then the patients are classified according to which drugs and treatments are suitable for them.
This means that if a new concept of specific drug comes out that can treat breast cancer patients with certain characteristics, our existing breast cancer classification will likely be changed again for it.
For example, at this year's ASCO, Professor Modi from New York shared the new anti-cancer drug T-DXd (full name: Trastuzumab Deruxtecan), which not only broke the "tradition" that targeted therapy is not recommended for HER2-negative breast cancer patients, but also made HER2-low Expression" of breast cancer patients using T-Dxd is significantly better than the current standard therapy: chemotherapy - the overall median progression-free survival increased from 5.1 months to 9.9 months, nearly doubling . This gratifying result has led many people to believe that patients with low HER2 expression should be separately classified as a new subtype, so we must also redefine the classification of breast tumors and .
Of course, this is another story. If there is an opportunity in the future, we can write a separate article to talk about the new progress of targeted drugs for breast cancer. Today I will first take you to understand the basis for classifying breast cancer. This determines how everyone is treated.
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The American Society of Clinical Oncology (ASCO) is one of the world's leading oncology professional academic organizations. It has more than 21,500 experts in the field of oncology from more than 100 countries as its members. Its authority is like a movie. The Oscars of the festival, the Grammys of music..
- What are the three main aspects of breast cancer classification currently?
PR: is the English abbreviation of progesterone receptor. The higher the positive rate, the better the effect of endocrine therapy on .
ER: is the English abbreviation of estrogen receptor . Like PR, the higher the positive rate, the better the effect of endocrine therapy.
HER2: is an immunohistochemical indicator. But generally speaking, if HER-2 is positive, it often indicates that the tumor will progress more rapidly, will be more prone to recurrence and metastasis, and the prognosis will be relatively poor. But if the ER2 positivity rate is higher, it also indicates that the targeted therapy is more effective.
- Is it better to be positive or negative for PR, ER and Her-2? Which of these types is the most treatable?
According to the prognostic effect, we can divide these types into four parts :
The first echelon | Luminal A type
This is the type with the best prognosis of breast cancer.
This includes PR positive, ER positive, Her-2 negative, Ki-67 <14%.>
For patients with Luminal A type, the only drawback is that they are not suitable for targeted therapy.
The second echelon | Luminal B type
This is the type with the second best prognosis of breast cancer.
This includes PR positive , ER positive , Her-2 positive /PR positive , ER positive , Her-2 negative , Ki- 67 High expression (≥14%)
Luminal B type patients if the tumor is In the early stage, if there is no lymph node metastasis or distant metastasis, modified radical mastectomy for breast cancer can generally be performed, followed by adjuvant chemotherapy depending on the situation. Patients who are estrogen receptor, progesterone receptor positive, or human epidermal growth factor receptor positive can also choose targeted therapy. After comprehensive treatment, it is entirely possible for patients with Luminal B type to be completely cured. Of course, if the tumor is discovered late and has metastasized, the possibility of complete cure is relatively low.
The third echelon | HER-2 positive breast cancer
The treatment effect is relatively poor, and recurrence and metastasis are prone to occur after surgery.
This includes PR negative , ER negative , HER-2 positive.
When HER-2 is found to be positive, it means that the occurrence of breast cancer is not particularly related to estrogen and progesterone in the body, so there is no need to use endocrine therapy. The current treatment methods for this group of patients are relatively simple, basically relying on targeted therapy.
The fourth echelon | Triple negative breast cancer
This is the type with the worst treatment effect among all categories of breast cancer.
When PR, ER, and Her-2 are all negative, it is the most difficult to treat triple negative breast cancer.
Triple-negative breast cancer is basically insensitive to endocrine therapy and targeted therapy. Currently, it is mainly treated with chemotherapy, and the prognosis is also poor.
However, with the iteration of medical technology, some patients with triple-negative breast cancer also have new treatment options. For example, Her-2-negative patients have great hope to achieve better results than chemotherapy through targeted therapy and immunotherapy in the next few years.
- How does accurate examination help in treatment?
Many people think that the current inspection is very cumbersome and detailed. But in fact, with the gradual implementation of precision medicine, our examination of breast tumors will become more and more detailed.
For example, when many breast patients look at their pathology reports, they will find a number next to the HER2 indicator, which is divided into 4 levels, namely 0, 1+, 2+ or 3+. The larger the number, the higher the expression of HER2 protein in the tumor.
In our current classification, only breast cancers with particularly high HER2 expression (3+ and partial 2+) are called positive, while 0, 1+ and the remaining 2+ are all classified as negative. But in fact, 1+ and 2+ mean that the tumor cells express HER2. There is a difference between them and 0, which means no expression at all.
Currently, at least three-quarters of HER2-negative patients still have HER2 protein, but at lower levels. Existing targeted drugs are difficult to accurately treat them. So now we still classify these three-quarters of people as HER2 negative. However, at this year’s ASCO conference, with the launch of the new anti-cancer drug T-DXd, it can be seen that as the technology of targeted therapy improves in the future, there is a high probability that these HER2-negative people can use immunotherapy and achieve success. Better results.
Therefore, don’t be bothered by the examination. Only by “knowing yourself and knowing the enemy” can you make the most accurate and scientific treatment.
Of course, I want to emphasize it in the end: Now we have clearly explained the three indicators of PR, ER, and HER-2, but these three indicators cannot ultimately determine the prognosis of breast cancer. There are many factors that need to be considered together, such as tumor stage , the size of the primary tumor, whether there is axillary lymph node metastasis, whether there is metastasis to liver, lungs and other distant organs, etc.
Finally, I wish everyone can get the best treatment~
