Recent advances in breast cancer treatment.

Breast cancer treatment is determined by the molecular subtype both in the early stage and the advanced disease. While there is clear benefit from adjuvant systemic treatment for patients with early-stage triple negative and HER2 positive breast cancer, it was unclear in the past which patient with luminal breast cancer needs adjuvant chemotherapy. As a result, we used to overtreat or undertreat patients. In the era of personalized treatment, genomic panels have become as or more important than the anatomic extent of disease to define prognosis in luminal breast cancer. Several gene expression assays are available for consideration of adjuvant systemic therapy categorizing patients according to genomic risk for recurrence (e.g., Oncotype, Mammaprint, etc). Except for the high and low risk signature, more recently Mammaprint announced that patients with ultra-low risk signature have excellent prognosis, distinctive from low risk with 8-year BCSS above 99%, regardless of age, clinical risk or treatment received. Very few patients developed distant metastasis, allowing physicians to de-escalate treatment plans.