New treatment strategies in the management of breast cancer

Growing understanding of the molecular characteristics of breast cancer is raising the possibility of ultimately delivering therapies that are tailored to the tumour biology of the individual patient. Agents that are currently being evaluated in metastatic breast cancer, irrespective of specific markers such as human epidermal growth factor receptor-2 (HER2) or oestrogen receptor, include the novel microtubule inhibitor eribulin mesylate, and a monoclonal antibody directed against vascular endothelial growth factor-A, bevacizumab. Denosumab, a receptor activator of nuclear factor (B ligand (RANKL) inhibitor, has recently been demonstrated to improve bone-related métastases in patients with breast cancer, irrespective of biological phenotype. Targeted therapies directed against DNA repair mechanisms such as poly(ADP ribose) polymerase (PARP) may prove particularly useful in the treatment of triple-negative breast cancer. Turning to the adjuvant setting in patients with HER2-positive breast cancer, recent studies have shown that concomitant treatment with taxanes and trastuzumab improves survival, and data with novel anti-HER2 agents are emerging. Current adjuvant and metastatic studies are evaluating novel targeted treatments aimed at HER2 and other targets. Molecular profiling of tumours is providing and will further provide the needed answers related to therapeutic optimisation.