Breast cancer is the most common malignancy among women globally, with an increasing incidence rate that poses a significant threat to women's health worldwide. Molecular typing aids in the precise classification and stratified treatment of breast cancer. The continuous development of immunotherapy and targeted therapy offers new treatment options for patients with different types. At the recent 2023 China Conference of Integrated Oncology (CCHIO 2023), "Tumor Watch" had the opportunity to interview Professor Zhang Jin from Tianjin Medical University Cancer Hospital at the venue. Professor Zhang discussed the current state of breast cancer research in China, reviewed the evolution of breast cancer treatment strategies, and shared insights into the precision treatment of patients with different types.Oncology Frontier: In the international session of this CCHIO, experts from around the world shared their experiences in cancer control. Regarding breast cancer screening and diagnosis, what do you think are the unique characteristics of China? And what beneficial experiences have you observed from other countries? Could you please share with us?
- Professor Zhang Jin: Breast cancer has become the world’s most prevalent cancer. It is one of the most common malignancies among women, ranking first in incidence among female cancers, posing a significant threat to the physical and mental health of women in China and globally. This CCHIO conference in Tianjin brought together top oncology experts from around the world to share cutting-edge research in oncology, including breast cancer, as well as new diagnostic and treatment methods. The conference presented advancements in the field across five dimensions: prevention, screening, diagnosis, treatment, and recovery, marking a scholarly feast for the Chinese oncology community.
- Through this conference, we can see that breast cancer research is at the forefront of solid tumor research worldwide. I want to emphasize that the achievements in breast cancer research by our domestic colleagues, whether shared at the conference or about to be published, have reached or even surpassed the international frontier. This conference also facilitated in-depth exchanges with international counterparts, including the latest technological methods and innovative concepts in breast cancer diagnosis and treatment. I believe this conference was extremely fruitful.
Oncology Frontier: You participated in the discussion on “New Models of Patient Classification Management and the Realization of Precision Treatment under New Typing.” What do you think are the significant changes in the classification and management of breast cancer treatment currently?
- Professor Zhang Jin: This is an excellent question. I am pleased to see that the latest advancements in breast cancer were included in the top ten frontier developments in malignant tumors recently announced in China. In fact, the treatment of human breast cancer has roughly undergone three revolutions. The first revolution began in 1894 when American surgeon William Stewart Halsted established the radical mastectomy (Halsted technique), leading the development of local treatment for solid tumors at that time. Then, as our understanding of breast cancer deepened, surgical treatment gradually moved to breast and axillary preservation, marking the second revolution – the understanding that breast cancer is a systemic disease that can be treated with a combination of systemic and local approaches. The third revolution arrived with molecular typing, categorizing breast cancer into Luminal A, Luminal B, Triple Negative, and HER2 Positive types. The advent of molecular typing significantly improved patients’ disease-free and overall survival, signifying that classification treatment had entered the realm of breast cancer.
- Previously, these three revolutions were completed and led by foreign experts. However, now, the latest breast cancer research in China has brought us to a new stage of precision diagnosis and treatment. Through a deeper understanding of the molecular nature of primary breast cancer cells and further precision subdivision based on existing molecular typing, Chinese researchers have made significant contributions to the diagnosis and treatment of breast cancer for all humanity. The research led by Chinese scholars and the voices from Chinese researchers will further improve the survival of breast cancer patients in China.
Oncology Frontier: In recent years, there have been emerging new treatment strategies in the neoadjuvant therapy field for early-stage breast cancer, from HER2 positive to HR positive patients, each having their own enhanced treatment plans. How do you view the progress in early treatment of breast cancer?
- Professor Zhang Jin: This question hits right at the core of our clinical practice and the overall benefit for our breast cancer patients. Currently, the neoadjuvant and adjuvant treatment for different molecular subtypes of breast cancer has entered a new phase. This phase ranges from neoadjuvant sequencing to adjuvant, from primary tumor to regional control to systemic treatment, improving patients’ disease-free survival through these individualized comprehensive treatment approaches. We know that the goal of neoadjuvant therapy is to achieve pathological complete response (pCR), and pCR in the primary tumor and regional lymph nodes will translate into future disease-free survival benefits for patients. Different combination regimens will sequentially play a role in both neoadjuvant and adjuvant treatment stages.
- Under these circumstances, I believe that patients, whether with luminal, triple-negative, or HER2 positive types, can benefit. Among these, the transformation in the diagnosis and treatment of HER2 positive patients is quite significant. With the development of Antibody-Drug Conjugates (ADCs), these drugs now cover HER2 positive breast cancer comprehensively, from early to late stages, from neoadjuvant to adjuvant. We also look forward to more novel ADC drugs entering clinical use to benefit patients of other subtypes. Moreover, as seen in the recent ESMO conference and the ASCO conference earlier this year, immunotherapy, in addition to its role in the neoadjuvant/adjuvant treatment of triple-negative breast cancer, has also played a comprehensive treatment role from neoadjuvant to adjuvant in HR positive subtypes, significantly improving the disease-free survival of patients with different breast cancer subtypes.
