The Role of Immunotherapy and Gene Therapy in The Treatment of Breast Cancer in Middle-Aged Women: Integration with Pathomorphological Markers and Organ-Preserving Surgery

Abstract

This article analyses modern, biologically targeted approaches to the treatment of breast cancer in middle-aged women. The main focus is on determining the pathomorphological and molecular characteristics of the tumour, the role of immunotherapy, particularly in triple-negative breast cancer, the current level of clinical research on gene therapy, and the possibilities for reducing the extent of surgery. In breast cancer, the choice of treatment is determined by the histological type and grade of the tumour, lymph node status, estrogen receptor (ER), progesterone receptor (PR) and HER2 status, proliferative activity and other biomarkers. Modern neoadjuvant systemic therapy, including pembrolizumab-based chemoimmunotherapy, increases the likelihood of a pathological complete response in certain early-stage triple-negative tumours and allows surgery to be individualised. Gene therapy encompasses such areas as p53, oncolytic viruses, immunomodulatory genes, siRNA/shRNA, gene editing and genetic vaccines; however, in breast cancer most of these approaches remain at the clinical research stage. The role of the pathologist is not limited to diagnosis but is also essential in assessing response to treatment and selecting subsequent therapy. Organ-preserving and oncoplastic surgery, in turn, makes it possible in suitable patients to reduce surgical trauma and functional and aesthetic losses while maintaining oncological control.