Although this undoubtedly incomplete list of breast cancer therapies approved by the FDA would seem a veritable cornucopia of opportunities, for the over 1 million women world-wide who are diagnosed each year with breast cancer (Porter P. NEJM. 358:213–216, 2008), and their physicians, the list often seems much too short. Many of the drugs appear more than once on the list, as their indications have expanded over the time. This reflects the fact that many experimental agents have failed to meet the standards required for FDA approval, and also the realism that has marked cancer research in the last decade as we strive for incremental improvement rather than the “magic bullet” that was so long the goal. This latter point is the foundation for the work presented in this issue of CCR Focus. In Pathways to Personalized Medicine, we see breast cancer, invasive ductal carcinoma, as not one disease, but rather a collection of different disease entities, a collection of multiple different disease entities that likely have different cells of origin. At least five different subtypes have been described and there are likely others. Moreover, these cancers are found in patients whose unique genotypes may have determined their cancer susceptibility, both in terms of risk and in response to therapy. The sorting of genotypes and tumor types requires a meticulous study of breast cancer at a depth and scale not previously possible.
The articles in this issue of CCR Focus, guest edited by expert Olufunmilayo I. Olopade, highlight the emerging findings and ongoing studies in this field. Garcia-Closas and Chanock illustrate the value of genome wide-association studies in breast cancer risk. Schneider and colleagues discuss the appositely named triple-negative subtype and the need to find therapies that exploit its biology. Dowsett and Dunbier explore biomarkers that should provide a more accurate view of the biology of any given tumor, while Tan and colleagues teach us that an individual's genotype can have a surprising and profound effect on therapy response. Olopade lays the groundwork for these papers in an overview that highlights the optimism that these lines of research have generated in the oncology and advocacy communities alike. As with every issue of CCR Focus, it is our hope that the articles inform and intrigue both the expert in the field and the interested but non-expert observer. In breast cancer, as in all cancers, our hope is also that the next 15 years will bring better and less toxic therapies and a personalized path to the cure.
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