Advances in the diagnosis and treatment of early breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YE Songqing , WANG Ruijuan , HUANG Xiangqin

Department of Breast Surgery, Fujian Provincial Hospital, Fuzhou 350001, P. R. China;

Corresponding author：

YE Songqing, Email: 1797017169@qq.com

Keywords：

early breast cancer; adjuvant therapy; immunotherapy; survivorship care

DOI：

10.7507/1007-9424.202407102

Video：

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The progress of new therapies for solid tumors usually gradually transitions from late stage to early stage. Early treatment of Luminal breast cancer has entered the era of “endocrine therapy +”, with the strengthening of treatment duration and intensity, combined with targeted therapy and multi-gene detection, which still coexist with clinical parameters. For HER2-positive early breast cancer, neoadjuvant therapy has changed the treatment process, requiring exploration of precise strengthening and de-escalation of neoadjuvant therapy. “Neoadjuvant therapy changes adjuvant therapy, and early treatment affects recurrence treatment”. Although the early treatment of triple-negative breast cancer once showed a complicated state of “a hundred schools of thought contend”, today’s treatment strategy is far from focusing on the simple respond of those three negative markers. The core lies in precise diagnosis and classification for treatment! This article summarizes the progress of early breast cancer diagnosis and treatment, in order to provide valuable reference for clinicians’ practical application.

Citation： YE Songqing, WANG Ruijuan, HUANG Xiangqin. Advances in the diagnosis and treatment of early breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1033-1037. doi: 10.7507/1007-9424.202407102 Copy

1.	Bartels SAL, Donker M, Poncet C, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol, 2023, 41(12): 2159-2165.
2.	Montagna G, Laws A, Ferrucci M. GS02-02: Are nodal ITCs after neoadjuvant chemotherapy an indication for axillary dissection? The OPBC05/EUBREAST-14R/ ICARO study. Cancer Res, 2024, 84(9_Suppl): GS02-02. https://doi.org/10.1158/1538-7445. SABCS23-GS02-02.
3.	de Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer, 2017, 17(1): 379. doi: 10.1186/s12885-017-3361-y.
4.	Mamounas E, Bando H, White J. GS02-07: Loco-regional irradiation in patients with biopsy-proven axillary node involvement at presentation who become pathologically node-negative after neoadjuvant chemotherapy: primary outcomes of NRG Oncology/NSABP B-51/RTOG 1304. Cancer Res, 2024, 84 (9_Suppl): GS02-07-GS02-07. https://doi.org/10.1158/1538-7445.SABCS23-GS02-07 .
5.	Chadha M, White J, Swain SM, et al. Optimal adjuvant therapy in older (≥70 years of age) women with low-risk early-stage breast cancer. NPJ Breast Cancer, 2023, 9(1): 99. doi: 10.1038/s41523-023-00591-6.
6.	Kunkler IH, Williams LJ, Jack WJL, et al. Breast-conserving surgery with or without irradiation in early breast cancer. N Engl J Med, 2023, 388(7): 585-594.
7.	Jagsi R, Griffith K, Harris E. GS02-08: Five-year outcomes of the IDEA trial of endocrine therapy without radiotherapy after breast-conserving surgery for postmenopausal patients age 50-69 with genomically-selected favorable StageⅠ breast cancer. Cancer Res, 2024, 84(9_Suppl): GS02-08. https://doi.org/10.1158/1538-7445.SABCS23-GS02-08.
8.	Riaz N, Jeen T, Whelan TJ, et al. Recent advances in optimizing radiation therapy decisions in early invasive breast cancer. Cancers (Basel), 2023, 15(4): 1260. doi: 10.3390/cancers15041260.
9.	Curigliano G, Burstein HJ, Gnant M, et al. Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol, 2023, 34(11): 970-986.
10.	Gray RG, Bradley R, Braybrooke J, et al. Effects of ovarian ablation or suppression on breast cancer recurrence and survival: patient-level meta-analysis of 14 993 premenopausal women in 25 randomized trials. J Clin Oncol, 2023, 41(16_Suppl). https://doi.org/10.1200/JCO.2023.41.16_suppl.503.
11.	Rastogi P, O'Shaughnessy J, Martin M, et al. Adjuvant abemaciclib plus endocrine therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative, high-risk early breast cancer: Results from a preplanned monarchE overall survival interim analysis, including 5-year efficacy outcomes. J Clin Oncol, 2024, 42(9): 987-993.
12.	Turner N, Reis-Filho JS, Goetz M. GS03-06: Genomic and transcriptomic profiling of primary tumors from patients with HR⁺, HER2^-, node-positive, high-risk early breast cancer in the monarchE trial. Cancer Res, 2024, 84(9_Suppl): GS03-06. https://doi.org/10.1158/1538-7445.SABCS23-GS03-06.
13.	Slamon DJ, Stroyakovskiy D, Yardley DA, et al. Ribociclib and endocrine therapy as adjuvant treatment in patients with HR⁺/HER2^- early breast cancer: primary results from the phaseⅢ NATALEE trial. J Clin Oncol, 2023, 41(17_Suppl). https:// doi.org/10.1200/JCO.2023.41.17_suppl.LBA500.
14.	Rugo HS, Delord JP, Im SA, et al. Safety and antitumor activity of pembrolizumab in patients with estrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer. Clin Cancer Res, 2018, 24(12): 2804-2811.
15.	Cardoso F, McArthur HL, Schmid P, et al. LBA21 KEYNOTE-756: Phase Ⅲ study of neoadjuvant pembrolizumab (pembro) or placebo (pbo) + chemotherapy (chemo), followed by adjuvant pembro or pbo + endocrine therapy (ET) for early-stage high-risk ER⁺/HER2^– breast cancer. Ann Oncol, 2023, 34(Suppl 2): S1260-S1261. https://www.annalsofoncology.org/article/S0923-7534(23)04155-8/fulltext.
16.	Loi S, Curigliano G, Salgado RF, et al. LBA20: A randomized, double-blind trial of nivolumab (NIVO) vs placebo (PBO) with neoadjuvant chemotherapy (NACT) followed by adjuvant endocrine therapy (ET) ± NIVO in patients (pts) with highrisk, ER⁺HER2⁻ primary breast cancer (BC). Ann Oncol, 2023, 34: S1259-S1260. https://doi.org/10.1016/j.annonc.2023.10.010.
17.	Cardoso F, O’Shaughnessy J, McArthur H. GS01-02: Phase 3 study of neoadjuvant pembrolizumab or placebo plus chemotherapy, followed by adjuvant pembrolizumab or placebo plus endocrine therapy for early-stage high-risk ER⁺/HER2⁻ breast cancer: KEYNOTE-756. Cancer Res, 2024, 84(9_Suppl): GS01-02. https://doi.org/10.1158/1538-7445.SABCS23-GS01-02.
18.	Loi S, Curigliano G, Salgado R. GS01-01: Biomarker results in high-risk estrogen receptor positive, human epidermal growth factor receptor 2 negative primary breast cancer following neoadjuvant chemotherapy ± nivolumab: an exploratory analysis of CheckMate 7FL. Cancer Res, 2024, 84(9_Suppl): GS01-01. https://doi.org/10.1158/1538-7445.SABCS23-GS01-01.
19.	Schmid P, Cortes J, Dent R. LBO1-01: Neoadjuvant pembrolizumab or placebo plus chemotherapy followed by adjuvant pembrolizumab or placebo for early-stage triple-negative breast cancer: updated event-free survival results from the phase 3 KEYNOTE-522 study. Cancer Res, 2024, 84(9_Suppl): LBO1-01. https://doi.org/10.1158/1538-7445. SABCS23-LBO1-01.
20.	Ignatiadis M, Bailey A, McArthur H. GS01-03: Adding atezolizumab to adjuvant chemotherapy for stage II and III triple-negative breast cancer is unlikely to improve efficacy: interim analysis of the ALEXANDRA/IMpassion030 phase 3 trial. Cancer Res, 2024, 84(9_Suppl): GS01-03. https://doi.org/10.1158/1538-7445.SABCS23-GS01-03.
21.	Gianni L, Huang CS, Egle D, et al. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple-negative, early high-risk and locally advanced breast cancer: NeoTRIP Michelangelo randomized study. Ann Oncol, 2022, 33(5): 534-543.
22.	Loibl S, Mano MS, Untch M. GS03-12: Phase Ⅲ study of adjuvant ado-trastuzumab emtansine vs trastuzumab for residual invasive HER2-positive early breast cancer after neoadjuvant chemotherapy and HER2-targeted therapy: KATHERINE final IDFS and updated OS analysis. Cancer Res, 2024, 84(9_Suppl): GS03-12. https://doi.org/10.1158/1538-7445.SABCS23-GS03-12.
23.	Chan DSM, Vieira R, Abar L, et al. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer, 2023, 152(4): 572-599.
24.	Ligibel JA, Ballman KV, McCall LM, et al. Effect of a telephone-based weight loss intervention (WLI) on weight at 12-months in women with early breast cancer: results from the Breast Cancer Weight Loss (BWEL) trial. J Clin Oncol, 2023, 41(16_ Suppl). https://doi.org/10.1200/JCO.2023.41.16_suppl.12001.
25.	Partridge AH, Niman SM, Ruggeri M, et al. Interrupting endocrine therapy to attempt pregnancy after breast cancer. N Engl J Med, 2023, 388(18): 1645-1656.
26.	Azim HA, Niman SM, Partridge AH. GS02-11: Fertility preservation and assisted reproductive technologies (ART) in breast cancer (BC) patients (pts) interrupting endocrine therapy (ET) to attempt pregnancy. Cancer Res, 2024, 84(9_Suppl): GS02-11. https://doi.org/10.1158/1538-7445.SABCS23-GS02-11.
27.	Lambertini M, Blondeaux E, Agostinetto E, et al. Pregnancy after breast cancer in young BRCA carriers: An international hospital-based cohort study. JAMA, 2024, 331(1): 49-59.

1. Bartels SAL, Donker M, Poncet C, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS trial. J Clin Oncol, 2023, 41(12): 2159-2165.
2. Montagna G, Laws A, Ferrucci M. GS02-02: Are nodal ITCs after neoadjuvant chemotherapy an indication for axillary dissection? The OPBC05/EUBREAST-14R/ ICARO study. Cancer Res, 2024, 84(9_Suppl): GS02-02. https://doi.org/10.1158/1538-7445. SABCS23-GS02-02.
3. de Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial. BMC Cancer, 2017, 17(1): 379. doi: 10.1186/s12885-017-3361-y.
4. Mamounas E, Bando H, White J. GS02-07: Loco-regional irradiation in patients with biopsy-proven axillary node involvement at presentation who become pathologically node-negative after neoadjuvant chemotherapy: primary outcomes of NRG Oncology/NSABP B-51/RTOG 1304. Cancer Res, 2024, 84 (9_Suppl): GS02-07-GS02-07. https://doi.org/10.1158/1538-7445.SABCS23-GS02-07 .
5. Chadha M, White J, Swain SM, et al. Optimal adjuvant therapy in older (≥70 years of age) women with low-risk early-stage breast cancer. NPJ Breast Cancer, 2023, 9(1): 99. doi: 10.1038/s41523-023-00591-6.
6. Kunkler IH, Williams LJ, Jack WJL, et al. Breast-conserving surgery with or without irradiation in early breast cancer. N Engl J Med, 2023, 388(7): 585-594.
7. Jagsi R, Griffith K, Harris E. GS02-08: Five-year outcomes of the IDEA trial of endocrine therapy without radiotherapy after breast-conserving surgery for postmenopausal patients age 50-69 with genomically-selected favorable StageⅠ breast cancer. Cancer Res, 2024, 84(9_Suppl): GS02-08. https://doi.org/10.1158/1538-7445.SABCS23-GS02-08.
8. Riaz N, Jeen T, Whelan TJ, et al. Recent advances in optimizing radiation therapy decisions in early invasive breast cancer. Cancers (Basel), 2023, 15(4): 1260. doi: 10.3390/cancers15041260.
9. Curigliano G, Burstein HJ, Gnant M, et al. Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol, 2023, 34(11): 970-986.
10. Gray RG, Bradley R, Braybrooke J, et al. Effects of ovarian ablation or suppression on breast cancer recurrence and survival: patient-level meta-analysis of 14 993 premenopausal women in 25 randomized trials. J Clin Oncol, 2023, 41(16_Suppl). https://doi.org/10.1200/JCO.2023.41.16_suppl.503.
11. Rastogi P, O'Shaughnessy J, Martin M, et al. Adjuvant abemaciclib plus endocrine therapy for hormone receptor-positive, human epidermal growth factor receptor 2-negative, high-risk early breast cancer: Results from a preplanned monarchE overall survival interim analysis, including 5-year efficacy outcomes. J Clin Oncol, 2024, 42(9): 987-993.
12. Turner N, Reis-Filho JS, Goetz M. GS03-06: Genomic and transcriptomic profiling of primary tumors from patients with HR⁺, HER2^-, node-positive, high-risk early breast cancer in the monarchE trial. Cancer Res, 2024, 84(9_Suppl): GS03-06. https://doi.org/10.1158/1538-7445.SABCS23-GS03-06.
13. Slamon DJ, Stroyakovskiy D, Yardley DA, et al. Ribociclib and endocrine therapy as adjuvant treatment in patients with HR⁺/HER2^- early breast cancer: primary results from the phaseⅢ NATALEE trial. J Clin Oncol, 2023, 41(17_Suppl). https:// doi.org/10.1200/JCO.2023.41.17_suppl.LBA500.
14. Rugo HS, Delord JP, Im SA, et al. Safety and antitumor activity of pembrolizumab in patients with estrogen receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer. Clin Cancer Res, 2018, 24(12): 2804-2811.
15. Cardoso F, McArthur HL, Schmid P, et al. LBA21 KEYNOTE-756: Phase Ⅲ study of neoadjuvant pembrolizumab (pembro) or placebo (pbo) + chemotherapy (chemo), followed by adjuvant pembro or pbo + endocrine therapy (ET) for early-stage high-risk ER⁺/HER2^– breast cancer. Ann Oncol, 2023, 34(Suppl 2): S1260-S1261. https://www.annalsofoncology.org/article/S0923-7534(23)04155-8/fulltext.
16. Loi S, Curigliano G, Salgado RF, et al. LBA20: A randomized, double-blind trial of nivolumab (NIVO) vs placebo (PBO) with neoadjuvant chemotherapy (NACT) followed by adjuvant endocrine therapy (ET) ± NIVO in patients (pts) with highrisk, ER⁺HER2⁻ primary breast cancer (BC). Ann Oncol, 2023, 34: S1259-S1260. https://doi.org/10.1016/j.annonc.2023.10.010.
17. Cardoso F, O’Shaughnessy J, McArthur H. GS01-02: Phase 3 study of neoadjuvant pembrolizumab or placebo plus chemotherapy, followed by adjuvant pembrolizumab or placebo plus endocrine therapy for early-stage high-risk ER⁺/HER2⁻ breast cancer: KEYNOTE-756. Cancer Res, 2024, 84(9_Suppl): GS01-02. https://doi.org/10.1158/1538-7445.SABCS23-GS01-02.
18. Loi S, Curigliano G, Salgado R. GS01-01: Biomarker results in high-risk estrogen receptor positive, human epidermal growth factor receptor 2 negative primary breast cancer following neoadjuvant chemotherapy ± nivolumab: an exploratory analysis of CheckMate 7FL. Cancer Res, 2024, 84(9_Suppl): GS01-01. https://doi.org/10.1158/1538-7445.SABCS23-GS01-01.
19. Schmid P, Cortes J, Dent R. LBO1-01: Neoadjuvant pembrolizumab or placebo plus chemotherapy followed by adjuvant pembrolizumab or placebo for early-stage triple-negative breast cancer: updated event-free survival results from the phase 3 KEYNOTE-522 study. Cancer Res, 2024, 84(9_Suppl): LBO1-01. https://doi.org/10.1158/1538-7445. SABCS23-LBO1-01.
20. Ignatiadis M, Bailey A, McArthur H. GS01-03: Adding atezolizumab to adjuvant chemotherapy for stage II and III triple-negative breast cancer is unlikely to improve efficacy: interim analysis of the ALEXANDRA/IMpassion030 phase 3 trial. Cancer Res, 2024, 84(9_Suppl): GS01-03. https://doi.org/10.1158/1538-7445.SABCS23-GS01-03.
21. Gianni L, Huang CS, Egle D, et al. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple-negative, early high-risk and locally advanced breast cancer: NeoTRIP Michelangelo randomized study. Ann Oncol, 2022, 33(5): 534-543.
22. Loibl S, Mano MS, Untch M. GS03-12: Phase Ⅲ study of adjuvant ado-trastuzumab emtansine vs trastuzumab for residual invasive HER2-positive early breast cancer after neoadjuvant chemotherapy and HER2-targeted therapy: KATHERINE final IDFS and updated OS analysis. Cancer Res, 2024, 84(9_Suppl): GS03-12. https://doi.org/10.1158/1538-7445.SABCS23-GS03-12.
23. Chan DSM, Vieira R, Abar L, et al. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer, 2023, 152(4): 572-599.
24. Ligibel JA, Ballman KV, McCall LM, et al. Effect of a telephone-based weight loss intervention (WLI) on weight at 12-months in women with early breast cancer: results from the Breast Cancer Weight Loss (BWEL) trial. J Clin Oncol, 2023, 41(16_ Suppl). https://doi.org/10.1200/JCO.2023.41.16_suppl.12001.
25. Partridge AH, Niman SM, Ruggeri M, et al. Interrupting endocrine therapy to attempt pregnancy after breast cancer. N Engl J Med, 2023, 388(18): 1645-1656.
26. Azim HA, Niman SM, Partridge AH. GS02-11: Fertility preservation and assisted reproductive technologies (ART) in breast cancer (BC) patients (pts) interrupting endocrine therapy (ET) to attempt pregnancy. Cancer Res, 2024, 84(9_Suppl): GS02-11. https://doi.org/10.1158/1538-7445.SABCS23-GS02-11.
27. Lambertini M, Blondeaux E, Agostinetto E, et al. Pregnancy after breast cancer in young BRCA carriers: An international hospital-based cohort study. JAMA, 2024, 331(1): 49-59.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in the diagnosis and treatment of early breast cancer

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