Editor’s Note: Breast cancer is one of the most common malignant tumors among women. Influenced by various factors, the incidence of breast cancer has been increasing year by year. With the addition of immunotherapy and targeted therapy, more breast cancer patients see hope for treatment. “Oncology Frontier” specially invited Professor Cuizhi Geng from The Fourth Hospital of Hebei Medical University to discuss the current state of diagnosis and treatment of breast cancer in China and the future directions for exploration in this field.
Oncology Frontier: Please discuss the current state of breast cancer diagnosis and treatment in China and the unmet clinical needs, based on your clinical practice.
Professor Cuizhi Geng: The “Healthy China 2030” planning outline clearly states that by 2030, comprehensive health management of chronic diseases across all populations and throughout the entire lifecycle should be achieved, and the overall 5-year cancer survival rate should be increased by 15%. As targeted therapies and immunotherapies gradually enter the Chinese market and are included in health insurance, the treatment options for breast cancer patients are increasing, and the survival benefits are becoming more apparent. As we move towards the goals of the “Healthy China 2030” plan, more Chinese breast cancer patients see the hope of cure, bringing more good news for their treatment. So, I believe that the treatment of breast cancer patients is currently at a good stage of development. Of course, we also have some unmet needs, such as how to further manage when resistance to targeted or immunotherapy drugs occurs. This issue is not only faced by breast cancer patients in China but is also a global challenge. Currently, experts and scholars in breast cancer diagnosis and treatment in China are working hard to address this issue collectively.
Oncology Frontier: Targeted therapies have made several breakthroughs in recent years. What impact do they have on clinical practice in China?
Professor Cuizhi Geng: The three main characteristics of targeted therapy drugs—precision in killing cancer cells, strong lethality, and good safety—have brought significant survival benefits to breast cancer patients. Various targeted therapies have already been introduced and applied clinically, including anti-HER2 targeted drugs, AKT inhibitors, PI3K inhibitors, and more. These targeted therapies have different therapeutic significances for different subtypes of breast cancer. Currently, targeted therapies have achieved good results in the treatment of various subtypes of breast cancer in China, and we look forward to the arrival of more targeted drugs to provide better survival for patients.
Oncology Frontier: Immunotherapy has become one of the important treatment options for TNBC. How should we consider efficacy, safety, and quality of life to develop personalized treatment plans?
Professor Cuizhi Geng: Currently, immunotherapy has achieved good therapeutic effects in the treatment of triple-negative breast cancer (TNBC). From the KEYNOTE-522 study, we know that in the neoadjuvant treatment setting, immunotherapy not only increased the pCR rate for TNBC patients but also led to better EFS outcomes. Moreover, in the treatment of advanced TNBC, we have seen survival benefits brought by immunotherapy. In the KEYNOTE-355 study, we observed that the pembrolizumab group, compared to the placebo group, extended patients’ PFS and OS. Immunotherapy has a promising future in the treatment of TNBC, and we are hopeful about its potential. However, due to the specificity of immunotherapy, which can attack organs throughout the body, it is crucial to thoroughly assess a patient’s health condition before using immunotherapy drugs. During the treatment, it is also necessary to timely evaluate the therapeutic effects and monitor for adverse events. Identifying concerns promptly allows for targeted treatment or timely cessation of the drug, enabling patients to achieve better treatment outcomes.
Oncology Frontier: What developments and explorations in the field of breast cancer in China are you most looking forward to?
Professor Cuizhi Geng: Currently, in the field of breast cancer treatment, China has achieved many accomplishments. For example, Professor Zhimin Shao’s team conducted a detailed analysis of the massive genomic data from 465 Chinese triple-negative breast cancer (TNBC) patients. They introduced the Fudan classification system for the first time internationally based on different genetic characteristics, categorizing TNBC into four different subtypes and proposing precise treatment strategies for each. This is of significant importance for TNBC patients in China. Moreover, in 2023, Professor Shao’s team announced the Fudan classification for HR+/HER2- breast cancer patients. Through multi-omics analysis, they further subdivided HR+/HER2- breast cancer into four subtypes. These subtypes show distinct biological behaviors and clinical characteristics, with corresponding treatment strategies differing as well.
Additionally, I hope that more registry studies and real-world study data based on Chinese patients will be published in the future. Since many drug registration study data are derived from patients outside China, we do not know how Chinese patients react to these medications, and we look forward to seeing more real-world research outcomes conducted by Chinese experts and scholars. Furthermore, I hope that China can develop vaccines against breast cancer, significantly reducing the incidence of the disease. With AI currently in a development boom, I hope it can be applied in the diagnosis of breast cancer in the future to improve the accuracy of patient diagnoses and thereby extend patients’ survival.
Professor Cuizhi Geng
Ph.D. in Surgery, Chief Physician, Second-Level Professor, Doctoral Supervisor
Vice Chairperson of the Breast Cancer Committee, Chinese Society of Clinical Oncology
Standing Committee Member of the Breast Cancer Committee, Chinese Anti-Cancer Association
Member of the Breast Cancer Study Group, Oncology Branch of the Chinese Medical Association
Standing Committee Member of the Breast Disease Specialist Training Committee, Chinese Medical Doctor Association
Chairperson of the Breast Cancer Committee, Hebei Province
