Predictive, preventive, and personalized medicine in breast cancer: targeting the PI3K pathway

Abstract

Breast cancer (BC) is a multifaceted disease characterized by distinct molecular subtypes and varying responses to treatment. In BC, the phosphatidylinositol 3-kinase (PI3K) pathway has emerged as a crucial contributor to the development, advancement, and resistance to treatment. This review article explores the implications of the PI3K pathway in predictive, preventive, and personalized medicine for BC. It emphasizes the identification of predictive biomarkers, such as PIK3CA mutations, and the utility of molecular profiling in guiding treatment decisions. The review also discusses the potential of targeting the PI3K pathway for preventive strategies and the customization of therapy based on tumor stage, molecular subtypes, and genetic alterations. Overcoming resistance to PI3K inhibitors and exploring combination therapies are addressed as important considerations. While this field holds promise in improving patient outcomes, further research and clinical trials are needed to validate these approaches and translate them into clinical practice. Graphical Abstract

Hallmarks of cancer resistance

“… 104 PI3K inhibitors have shown promise in preclinical studies. 105 There are different types of inhibitors that can be classified into three categories: dual PI3K/mTOR inhibitors, pan-PI3K inhibitors, and isoform-specific inhibitors. Among these inhibitors, idelalisib is a PI3K delta-specific inhibitor that has been approved by the United States Food and Drug Administration (FDA) for cancer treatment and has been proven to be effective.…”

Značaj Precizne Medicine I Farmakogenomike U Preventivnoj Pedijatriji

“…sprečavanje ispoljavanja različitih oboljenja ili se mogu odložiti manifestacije oboljenja za koje postoji predispozicija. (2,3,4) Koncept personalizovane medicine sastoji se u medicinskom tretmanu obolele osobe prema individualnim karakteristikama, uključujući genotip osobe. (5,6) Kako se genetika razvija, iako se često koristi termin "personalizovana medicina", postoji i noviji i precizniji termin -"precizna medicina".…”

“…Iako postoji uspeh ovakvog preventivnog pristupa, potrebna je kategorizacija podgrupa bolesti analizom fenotipa i genotipa pacijenata, kako bi se povećala uspešnost prevencije i lečenja i najčešćih i retkih bolesti. (11,13,4,15,16) Svaka obolela osoba je jedinstvena i predstavlja "unikat". Tradicionalni koncept pretpostavlja se da pacijenti sa "zajedničkim" znacima i simptomima bolesti dele isti patološki fenotip bolesti i pretpostavlja se da će reagovati slično na slične intervencije (medicinske, proceduralne i/ili bihevioralne).…”