[Molecular mechanisms and clinical applications of anti-angiogenic therapy in precision treatment of breast cancer].

Tumor angiogenesis is a crucial determinant of breast cancer progression and therapeutic response. This review first traces the proposal and evolutionary course of the tumor angiogenesis theory, and systematically collates its diverse occurrence patterns, including sprouting angiogenesis, intussusceptive angiogenesis, vascular mimicry and vascular co-option, while conducting an in-depth analysis of the heterogeneous characteristics of different patterns and their biological significance at various stages of tumor progression. At the molecular regulatory mechanism level, this paper focuses on summarizing the mechanisms of core regulatory networks, such as the hypoxia-inducible factor-1 axis, vascular endothelial growth factor/vascular endothelial growth factor receptor, platelet-derived growth factor/platelet-derived growth factor receptor, angiopoietin/angiopoietin receptor, and Delta-like ligand 4/Notch receptor signaling pathway. In addition, this paper comprehensively reviews the clinical exploration of anti-angiogenic therapy for breast cancer, and discusses the practical challenges faced by this therapeutic strategy, including unstable efficacy, drug resistance, the lack of precise stratification biomarkers and treatment-related toxicities. Finally, this paper proposes future research directions oriented toward precision therapy, including optimizing the vascular normalization window, developing patient stratification strategies based on multidimensional biomarkers, and deciphering tumor vascular heterogeneity by using spatial omics. These findings provide a theoretical reference for the optimization and innovation of anti-angiogenic therapy for breast cancer.