Professor Luo Ting: Looking forward to the future, the exploration and challenge of precise treatment of breast cancer

"The Status and Controversy of Breast Cancer Diagnosis and Treatment: Tourism of the Future 100 Scientific Issues" is a sincere work for the diagnosis and treatment of breast cancer in my country. Back to the road to pay tribute to the future "interview column, this issue specially invited Professor Luo Ting of Huaxi Hospital of Sichuan University , the current status of the diagnosis and treatment of breast cancer, The development trend of genetic testing and future research directions are discussed.

Paying: From molecular type to AI auxiliary diagnosis

Womens health, especially breast cancer, is becoming increasingly serious, and the trend of youngerness is obvious.Professor Luo Ting introduced that the prognosis of breast cancer is relatively good at present and has been regarded as chronic disease management.For specific patient groups, a variety of innovative therapy and high -efficiency new drugs have emerged, such as the Qua Port combination in anti -HER2 treatment, the light pyrotinib of the Chinese medicine, and the ADC drug DS8201;6 Targeting therapies such as inhibitors, re -gaining new hope.

However, the road to cure of breast cancer is still full of thorns.Taking tri -negative breast cancer as an example, although the immunotherapy and ADC drugs represented by SG have made progress, the overall effect is to be improved, and the current situation of the treatment is not fully rewritten;The challenges of the treatment of advanced hormone receptor patients after CDK4/6 inhibitors, and the neo-assisted treatment strategies of local advanced patients, still have many unsolved questions; as for the new assisted treatment of three-negative NON-PCR patientsA variety of treatment options such as treatment, Koriebin and BRCA mutation related PARP inhibitors exist, but its specific application solutions still need to be studied in depth.These issues are condensed from busy clinical practice. Clinicians should regard them as an opportunity to promote progress, and use the power of new drugs and new technologies to open up a variety of practical paths in the broad field with innovative thinking.

When exploring how to get closer to cure the ultimate goal of breast cancer, multiple levels of problems are worthy of inquiry.First of all, is the current classification method of breast cancer?At present, the potential of molecular level segmentation such as tri -negative quarter -type and hormone receptor -positive SNAP classifications, etc. The more fine classification methods may open a new chapter of personalized therapy.At the same time, AI auxiliary diagnostic technology is booming, especially in the application of images and pathological fields is gradually deepening.Looking forward to AI can become a doctoral assistant, help the formulation of more accurate diagnosis and treatment plans, and then improve the treatment effect.Imagine the future, which may be able to quickly depict the patients disease and drug resistance through simple liquid biopsy technology, and then use AIs intelligent matching to achieve rapid customization of treatment schemes.In addition, the application of innovative technologies such as VR is also full of imagination in the medical field. In the future, VR glasses may be worn, and the process of tumor changes and treatment can be observed intuitively.The later "the future has come."

Professor Luo Ting said with emotion to pay tribute to the future. The problem is far more than 100. Long roads are long and difficult.However, "without accumulating steps, no thousand miles", each worker and researchers in the field of breast cancer actively discover problems in their respective fields and seek answers.

Challenge continuous: from comprehensive assessment to dynamic monitoring

Inconsistent expression is common, and it has become the focus and difficulty in clinical practice.Professor Luo Ting explained that the cause of this phenomenon involves multiple aspects, and the heterogeneity of tumor is one of the key.Because cells in different areas inside the tumor may have different genetic characteristics and biological background, there are differences in the expression level of tumor markers.This heterogeneity not only exists in the different parts of the primary tumor, but also exists between the primary stove and the metastasis, and even between the cells in the same metastasis.Heterogeneous phenomena also occur in certain evolutionary processes, and timely heterogeneity.In the process of growth, invasion and metastasis, tumors will go through a series of genetic mutations and apparent genetic changes, or cause an increase or decrease in the expression of specific tumor markers.In the process of evolution, the metastasetic cord may also obtain molecular characteristics that are different from the original stove.

In addition, the impact of micro -environment on the change of tumor logo changes.Specifically, the metastases are located in different organ environment. In the micro -ring, cytokine, growth factors, metabolic products and other factors are different from the original site or, which will affect the biological characteristics of tumor cells.At the same time, different treatment methods, such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy, which can selectively inhibit or induce the expression of certain tumor markers in the primary stove and metastases.From the perspective of detection levels, technical factors such as the collection time, location, and processing method of the original stove and the transfer stove specimen may also affect the test results, which will cause inconsistency of the logo.

Therefore, the correlation between the above reasons and the prognosis is worth exploring and very challenging.In view of the inconsistent expression of tumor markers, a single logo is often difficult to comprehensively predict the follow -up behavior and prognosis of breast cancer. To this end, it is necessary to comprehensively consider the characteristics of multiple logo and the characteristics of clinical pathological history to comprehensively evaluate.It is worth noting that the effective treatment of abnormal expression of abnormalities for certain specific transfer stove markers may not be applicable to all metastases, which also highlights the importance of individualization.Individual chemotherapy strategies are both from the overall consideration and based on local characteristics.For the separate evaluation of each metastasis, including changes in the logo, it may be more timely reflecting the treatment response and the progress of the disease than the primary stove.Therefore, dynamic monitoring of changes in tumor logo will help better understand the evolution of the tumor and judge the prognosis.

Professor Luo Ting concluded that in clinical practice, monitor the changes in the tumor logo of the metastasis and the primary stove, combined with clinical manifestations, imaging, pathology and other characteristicsComprehensive evaluation of data can more accurately guide subsequent treatment decisions and make corresponding prognosis evaluations.

Update: From authoritative guidelines to clinical practice

With the development of precision diagnosis and treatment technology, breast glandsThe importance of cancer molecular typing in clinical practice is increasingly prominent.Professor Luo Ting recommends a number of authoritative guidelines and molecular diagnostic methods, including comprehensive consideration of molecular typing in the NCCN guide, and make good use of multi -gene tests such as Oncotype (21 genes), mammaprint (70 gene); ST. Gallen consensus consensusThe annual voting of the meeting also fully reflects the important role of molecular characteristics in layered treatment decisions; the ESMO guide also emphasizes the role of molecular markers in breast cancer diagnosis and treatment, and recommends a series of decision -making tools.The CSCO BC Guide (commonly known as the "Little Blue Book") and the "Little Red Book" released by CACA CBCS also discussed the chapters of molecular typing to show the early and advanced treatment strategies, emphasizing that accurate types of accurate treatment are the prerequisite for precise treatment.

In terms of molecular diagnosis methods, the immunohistochemistry is in the mainstream position due to its simplicity, and the FISH fluorescent in situ hybrid technology is further accurately detected.With the popularization of second -generation sequencing (such as NGS), the application of multi -gene detection scoring tools such as 21 genes and 70 genes in clinical testing provides strong support for patients with relapse risk assessment and chemotherapy guidance.

The prognostic assessment is currently focused on the reaction prediction of endocrine therapy for hormone receptor patients; HER2 -positive patients fight against HER2 targeted therapy;The expression state of PD-L1 provides an important basis for the treatment of tri-negative breast cancer treatment; gene testing such as BRCA to evaluate whether the PARP inhibitor can bring new treatment opportunities for patients with qualified patients.

Looking forward to the future of breast cancer diagnosis and treatment, Professor Luo Ting believes that the development trend will focus on the field of multi -gene testing and is committed to promoting treatment in the direction of precision and personalization.The core is to clarify which patients can really benefit from comprehensive treatment, while avoiding unnecessary treatment measures, thereby reducing the toxic response caused by treatment.For early patients, we strive to achieve cure; for advanced patients, we pursue high -efficiency and low toxic treatment plans, extend the survival period and improve the quality of life, and achieve the goal of "long and good living" that doctors and patients expect.not/strong>

Deputy Director of the Breast Disease Center of Huaxi Hospital of Sichuan University

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Chief physician, doctor of medicine, masters tutor

Standing Committee of the Standing Committee of the China Clinical Oncology Society of the China Clinical Oncology Society

Member of the China Clinical Oncology Society (CSCO BC)

Member of the China Anti -Cancer Association Breast Cancer Special Committee (CBCS)

China Anti -Cancer Association breast glandsSecretary -General of the Cancer Integration and Sieve special Committee

Chinese Medical Societys Oncology Branch Breast Tumor Study GroupYouth Member

Deputy Chairman of the Yangtze River Academic Band Breast Alliance

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Deputy Chairman of the Breast Cancer Special Committee of the Sichuan Provincial Anti -Cancer Association

Vice President of the Breast Professional Branch of the Sichuan Medical Association

Sichuan Provincial Society of Prevention and Medicine, President of the Standing Committee of the Prevention and Control Branch of the Sichuan Province, Chairman of the Youth Committee

Deputy Chairman of the Sichuan Cancer Society of Tumor Society

· Jinshan Camellia Plan "Outstanding Contribution Award in the breast cancer

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