chapter  18
Breast Cancer Stem Cells and Their Niche: Lethal Seeds in Lethal Soil
ByDanuta Balicki, Brian Leyland-Jones, Max S. Wicha
Pages 31

The quest for optimal breast cancer therapy has been thwarted by recurrent

treatment failures. As a result, the necessity has emerged to concomitantly rethink

the fundamental basis of breast cancer, and to ensure that it is adequately and

optimally targeted by therapeutic agents, and combinations of these agents.

Adding to the complexity of this disease is the heterogeneity of breast cancer, and

the realization that breast cancer is not a single disease, but a family of diseases.

The daunting challenge that we face with a newly diagnosed breast cancer patient

is one-to-one communication that tailors an individualized treatment strategy

based on the corresponding breast cancer pathophysiology. At the same time, we

are mandated to address the urgency of this therapy on the basis of the underlying

clinical assessment, the risks of metastases and death, as well as the benefits and

adverse effects associated with therapeutic regimens to ensure that an enlightened

decision among available therapeutic options can be mutually reached with an

individual patient. As our understanding of the pathophysiology of breast cancer is

incomplete, it is critical to channel the information that we glean from observations

that deviate from our current models into a unified paradigm shift where thera-

peutic targets are validated, and subsequently attacked and destroyed. Given the

complexity of breast cancer, the highest level of therapeutic success is most

likely to be achieved when the uniqueness of an individual patient’s breast

cancer is matched with individualized, combined, and targeted therapy.