Breast cancer is not a uniform disease, and there are several subgroups of classical histological types, which also show important differences in the course of the disease.

Determining the tumour’s oestrogen, progesterone receptor and HER-2 status (immunophenotype) is an integral part of the investigation for the purpose of therapy selection. In about 20% of cases, abnormalities in the HER-2 gene are responsible for the development of breast tumours.

The cure rates of previously worst prospective HER-2 positive breast cancers have improved spectacularly as a result of targeted treatments.

Several rare mutations may be involved in the development of breast cancer, which are not detected by routine testing, but can be detected by multigene testing and may represent additional therapeutic targets.

In the treatment of tumours, in addition to the classical oncological approach, precision oncology is increasingly gaining ground, resulting in a therapy that is selected based on the molecular properties of the tumour.

While in the classical oncological approach the treatment decision was based on the histological type and extent of the tumour, the knowledge of the molecular information of the tumours is essential for the choice of a personalized treatment. Molecular diagnostics and Oncompass Medicine’s multi-award-winning medical software help here.

For targeted treatment of breast cancer, a molecular diagnostic is needed before starting therapy.

Molecular diagnostics

All cancers have a genetic origin, and for many of the genetic mutations that cause cancer, personalized oncological treatment can already be given. Molecular diagnostics reveals the cause of the cancer, and based on the identified gene mutations, we use our proprietary, specialized medical software to identify the target of the tumour, or molecular target, and the personalized drugs that can be associated with that target.

In triple negative breast cancers, neither estrogen nor progesterone receptors nor HER2 protein are present. This is the most heterogeneous subgroup from a molecular diagnostic point of view, with many mutations playing a role in its development. The use of immune checkpoint inhibitors is of great importance in this subgroup.

The combination of molecular target and endocrine therapy has been a major advance in the treatment of hormone receptor positive breast cancer, both in early and metastatic stages, and is now an alternative to, and often superior to, conventional chemotherapy.

Hereditary types of breast cancer have defects in BRCA1 and BRCA2 or genes with similar functions (e.g. ATM). Mutations in the BRCA1 and BRCA2 genes cause hereditary breast and ovarian cancer and increase the incidence of male breast cancer, prostate cancer and pancreatic cancer in both sexes. These gene defects respond well to targeted treatment with e.g. PARP inhibitors.

Targeted treatment can only be safely based on a detailed genetic profile of the tumour, which is the only way to understand the behaviour of the tumour at the molecular level. In most cases, 600 genes are tested, with additional specific tests.

Of the 25,000 coding human genes, 600 are associated with tumor development. On average 4-5 different genes mutations per tumor are responsible for uncontrolled cell division. Therefore a detailed genetic profiling of a given tumor is necessary for making the right therapeutic decision. The more mutations are present in a tumor, the harder it is to select for molecular targets.

Digital therapy planning

Digital therapy planning refers to the personalized treatment and immunotherapy planning using digital drug assignment.

Our multiple times award-winning medical software, used for digital therapy planning, is unique in being able to rate and prioritize targeted treatment options within 20 milliseconds in 405 tumor types, based on 52 000 mutations, 26 838 rules and 1417 compounds using up to date scientific evidence.

Oncompass Medicine’s medical software helps doctors select the most effective, personalized, targeted treatment options for cancer patients in 20 milliseconds.

Find out more about digital therapy planning!

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If the tumour does not have a target gene abnormality, conventional chemotherapy may be supplemented with angiogenesis therapy.

This is based on the recognition that by inhibiting the formation of blood vessels that supply the tumour with nutrients, tumour growth can be stopped and the tumour can shrink.

 The framework of the personalized program is provided by a new medical procedure developed by Oncompass. The procedure includes all the services needed to set up a personalized treatment plan and puts them in an optimal order. The special procedure can help you and your doctor to identify and to apply personalized options.