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Predictive markers in breast cancer

04/2021 MUDr. Zuzana Bielčiková, Ph.D.
Prognostic and predictive markers are the way to the treatment personalization. Prediction of prognosis is important for stratifying the disease according to the risk of relapse and is a prerequisite for escalation or de-escalation of treatment. In the case of early hormone-sensitive (HR+) breast cancer, multigene assays (MGA) in particular fulfil this role. There are also hopes for the prognostic significance of proliferation activity of the disease (Ki 67) in response to neoadjuvant hormonal therapy. For aggressive subtypes (human epidermal growth factor receptor 2 - positive [HER2+] and triple negative breast cancer [TNBC]), main prognostic markers are the achievement of pathological complete remission and the presence of tumor infiltrating lymphocytes, programmed death ligand 1 (PD L1) also stayed in this category. The only and already established predictive markers of therapy response in early breast cancer remain the estrogen receptor (ER) and HER2. We're slightly better at predicting of therapy response in metastatic breast cancer; to ER and HER2 we can add PD L1 in metastatic TNBC, a mutation in the PIK3CA gene in HR+ cancer, and the presence of mutations in BRCA genes as predictors for inhibitors of PARP Prediction of therapeutic effect is also a prerequisite for improving patient survival and for reducing the toxicity of non-target treatment.
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Adjuvant chemotherapy in hormonal‑dependent breast cancer patients – options in using of multigene assays

04/2019 MUDr. Zuzana Bielčiková, Ph.D.
The time before 2000, when adjuvant chemotherapy was a standard part of the treatment of almost all breast cancers, including hormonal-dependent, is long gone. Multigene assays help us to clarify the biological behavior of estrogen/progesterone-positive tumors and thus the prognosis of patients. In the past, chemotherapy was indicated in the majority of patients without lymph node involvement, now is shown that even tumors with 1-3 metastatic lymph nodes may be those with a good prognosis that does not require chemotherapy. The challenge of the upcoming period is prognostic stratification of the disease according to the risk of relapse and predictive administration of systemic therapy. The more prognostic groups we create, the more targeted will be the treatment and the smaller group of patients will be exposed to its side effects.
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