Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer

Invasive Lobular Carcinoma of the Breast: Toward Tailoring Therapy?

“…However, few patients were considered as high risk with the RS (1.9%, n ¼ 40, vs 11% for IDC), the follow-up was low in this subcohort (48.2 months), and these patients had probably received adjuvant chemotherapy. Nevertheless, these findings are in line with several studies that observed a low rate of high-risk ILC patients (<5%-10%) with the RS, with controversial prognostic value [reviewed in (4)], even if a recent study in approximately 15 000 ILCs reported a statistically significant prognostic and predictive value of the RS (10). Therefore, to predict the prognosis for ILC patients, it might be more informative to use dedicated ILC signatures such as LobSig or other genomic tests, ILC (eg, MammaPrint, Prosigna, EPClin, Breast Cancer Index, Genomic Grade Index) and that were confirmed to be prognostic in this histologial type (such as MammaPrint, EPclin ...) [reviewed in (4)].…”

“…Nevertheless, these findings are in line with several studies that observed a low rate of high-risk ILC patients (<5%-10%) with the RS, with controversial prognostic value [reviewed in (4)], even if a recent study in approximately 15 000 ILCs reported a statistically significant prognostic and predictive value of the RS (10). Therefore, to predict the prognosis for ILC patients, it might be more informative to use dedicated ILC signatures such as LobSig or other genomic tests, ILC (eg, MammaPrint, Prosigna, EPClin, Breast Cancer Index, Genomic Grade Index) and that were confirmed to be prognostic in this histologial type (such as MammaPrint, EPclin ...) [reviewed in (4)]. Despite the prognostic prediction of these assays, the benefit of adding chemotherapy in the high-risk ILC group is debated in the adjuvant setting, in a general context where the benefit of chemotherapy is still discussed in ILC (11).…”

Circulating tumour DNA characterisation of invasive lobular carcinoma in patients with metastatic breast cancer

“…Defining novel therapeutic strategies for patients with metastatic ILC has been challenging due to discrepancies in pathology classification and inconsistent reporting of histology in clinical trials. 33 To our knowledge, no previous studies have explored differences in ctDNA profiles among patients with ILC, IDC, and MXD histologies. We hypothesised that we could detect differences in the genomic landscape of ctDNA across breast cancer histologies, and we explored the impact of individual alterations and oncogenic pathways on overall survival.…”

Genomic profiling and pre-clinical modelling of breast cancer leptomeningeal metastasis reveals acquisition of a lobular-like phenotype

“…The genomic findings also highlight the potential clinical value of CSF cfDNA profiling for patients affected by this condition, and support the notion that BCLM may be better treated by discovery of blood-brain/blood-CSF-barrier penetrant therapies rather than intrathecal cytotoxic chemotherapy. Importantly, the identification of cell-cell adhesion and cytoskeleton alterations both provides insight to the biology of BCLM and its ability to flourish in this metastatic site, but also presents a potential ‘Achilles-heel’ for therapeutic targeting, such as ROS1 inhibition 61 and other emerging approaches 72, 73 . The methodologies and novel models described here will serve as an important resource for the ongoing research into leptomeningeal metastasis with the overarching aim to improve therapeutic options and patient survival.…”