Eradication of breast cancer cells in patients with distant metastasis: the finishing touches?
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Abstract
Cytotoxic agents are significantly active in breast cancer cells, but their usefulness has been limited in treating metastatic breast cancer (MBC). This has facilitated the development of an approach using molecular-targeted agents. Intrinsic subtypes including luminal A, luminal B, human epidermal growth factor receptor type 2 (HER2)-enriched, basal-like, and claudin-low tumors exhibit original drug responsiveness and clinical prognosis. Anti-HER2 treatments, trastuzumab or lapatinib, have demonstrated clinically significant efficacy. Poly ADP-ribose polymerase-1 inhibitors act against BRCA1-disabled breast cancer. Cancer stem cells could be the major obstacle to achieving a cure in systemic treatment. Extensive investigations are underway to develop novel agents that act on the genes or signaling of Hedgehog, Wnt, and Notch, which regulate cancer stem cells. Cancer cells undergo epithelial–mesenchymal transition (EMT) and acquire invasive properties. Breast cancer cells alter their phenotype in blood and bone marrow, e.g., circulating tumor cells or disseminated tumor cells. Cancer stem cells, like normal stem cells, may exist at niches in bone marrow. To achieve a cure for MBC, it is necessary to disrupt cancer stem cell–niche interactions or eradicate cancer stem cells. Traditional treatments with cytotoxic or endocrine agents require development in relation to intrinsic subtypes, stem cells, or EMT.
Keywords
Breast cancer CTC DTC Stem cell Epithelial–mesenchymal transitionAbbreviations
- ALDH
Aldehyde dehydrogenase
- CTC
Circulating tumor cell
- CXCR4
C-X-C motif chemokine receptor-4
- DTC
Disseminated tumor cell
- Dvl
Cytoplasmic disheveled
- EMT
Epithelial–mesenchymal transition
- ER
Estrogen receptor
- HER2
Human epidermal growth factor receptor type 2
- MBC
Metastatic breast cancer
- PARP
Poly ADP-ribose polymerase
- PCR
Polymerase chain reaction
- PI3K
Phosphoinositide 3-kinase
- PR
Progesterone receptor
- Smo
Smoothened
- RANK
Receptor activator for nuclear factor κ B
- VEGF
Vascular endothelial growth factor
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