To explore treatment strategies based on the new subtyping result, it is also necessary to identify candidate therapeutic drugs for single-cell lncRNA subtypes. Drugs can indirectly target lncRNAs to exert antitumor efficacy by regulating lncRNA-related pathways or regulators. Therefore, we indirectly targeted lncRNA by identifying drugs that target lncRNA regulatory genes. For 7 lncRNA subtypes, 210 candidate drugs were identified and are shown in Table
1 and Additional file
6. We conducted direct (drug-disease relationships) or indirect (drug-target, target-disease relationships) literature verification on candidate drugs. In addition, the total literature verification rate is 86.2%. We found that some drugs are for only one lncRNA subtype, such as imatinib, which is only for subtype C1, and some drugs are suitable for multiple subtypes, such as canfosfamide, which is a therapeutic drug for the C4, C5 and C6 subtypes. Among these predicted drugs, we found that some drugs are currently used to treat PAM50 subtypes. For example, candidate drugs for C1, including trastuzumab, pertuzumb, lapatinib and sorafenib are commonly used for HER2-enriched subtypes. Fulvestrant, a commonly used drug for luminal A, is on the candidate drug list of C3. The history of TNF-α is closely related to the history of tumor immunotherapy [
62]. TNF-α is one of the most important pro-inflammatory cytokines found in breast cancer, mainly secreted by M1 activated macrophages [
63]. TNF-α belongs to the TNF/TNFR superfamily and is considered to be one of the most promising anti-cancer factors [
64]. TNF-α affects the development of BC at all stages, including the development of primary tumors, EMT, metastasis and disease recurrence [
65]. Therefore, a treatment plan related to TNF-α in BC has been produced: neutralization of endogenous TNF-α by TNF antagonists [
65]. In some preclinical studies, TNF-α antagonists have been shown to effectively inhibit the growth and spread of BC [
65]. The predicted TNF-targeted drugs are MSX-122, nimesulide, adalimumab, AME-527, certolizumab pegol, etanercept, golimumab, infliximab, and thalidomide. Etanercept can bind to TNF-α, thereby inhibiting its biological activity [
65]. Infliximab inhibits tumor growth and lymph node metastasis by combining molecular pathways mediated by TNF-α [
66]. In addition, when TNF-α stimulates BC, it will activate the transcription factors NFkβ and cJun, drive the transcription of EMMPRIN and MIF genes, and induce the increase of MMP secreted by macrophages in TME. It has been found to promote tumor cell invasion and metastasis [
67]. The drugs that target MMP family genes are marimastat, SC-74020, and UK-356618. Among which, marimastat can prevent tumor cell invasion and metastasis [
68,
69].
Table 1
Information of candidate drugs for each lncRNA subtype
C1 | 33 | 31 | 2 | C1; C2 | BMS-536924 |
C1; C2; C6; C7 | TW-37 |
C2 | 18 | 13 | 5 | C1; C2 | BMS-536924 |
C2; C6 | AMD-070 |
MSX-122 |
Plerixafor |
C1; C2; C6; C7 | TW-37 |
C3 | 45 | 44 | 1 | C3; C6; C7 | R547 |
C4 | 39 | 38 | 1 | C4; C5 | Curcumin |
C5 | 16 | 13 | 3 | C4; C5 | Curcumin |
C5; C6 | Canfosfamide |
Ezatiostat |
C6 | 34 | 22 | 12 | C1; C2; C6; C7 | TW-37 |
C2; C6 | AMD-070 |
MSX-122 |
Plerixafor |
C3; C6; C7 | R547 |
C5; C6 | Canfosfamide |
Ezatiostat |
C6; C7 | ABT-737 |
Obatoclax |
Phosphonothreonine |
SNS-032 |
THZ1 |
C7 | 42 | 35 | 7 | C1; C2; C6; C7 | TW-37 |
C3; C6; C7 | R547 |
C6; C7 | ABT-737 |
Obatoclax |
Phosphonothreonine |
SNS-032 |
THZ1 |
We hypothesized that the presence of multiple single-cell subtypes in a patient is the cause of treatment failure or even tumor recurrence. For patients with multiple subtypes, clinically, the patient may only display the phenotypic characteristics of the dominant subtype, and the phenotypic characteristics of minor/secondary subtypes will be covered up. Only treating the dominant subtype may result in poor treatment effects. For example, lncRNA subtype C1 accounted for the majority/dominance in patient BC05, followed by C7. Clinically, the tumor phenotype characteristics of C1 may cover those of the C7 subtype, and the patient phenotype apparently represents the C1 subtype. Usually, according to the current treatment strategy, BC05 is treated according to the C1 subtype. During the process of treatment, C1 cells are gradually eliminated, and C7 cancer cells appear, leading to drug resistance or a potential risk of recurrence. Therefore, for patients with multiple subtypes, we proposed new treatment strategies that should use targeting multi-subtype drugs or combinations of targeting single-subtype drugs to simultaneously treat the patient with multiple subtypes. For BC05, we can use a drug shared by two subtypes, such as TW-37, which is confirmed to effectively induces apoptosis in a dose-dependent manner [
70] or a combination of drugs to target C1 and C7 subtypes, such as pertuzumab [
71] and melatonin [
72]. Treatment strategies of other patients are in Additional file
7.