Department of Women's Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
Cancer Control. 2010 Jul;17(3):183-90. doi: 10.1177/107327481001700307.
Harnessing the immune response in treating breast cancer would potentially offer a less toxic, more targeted approach to eradicating residual disease. Breast cancer vaccines are being developed to effectively train cytotoxic T cells to recognize and kill transformed cells while sparing normal ones. However, achieving this goal has been problematic due to the ability of established cancers to suppress and evade the immune response.
A review of the literature on vaccines and breast cancer treatment was conducted, specifically addressing strategies currently available, as well as appropriate settings, paradigms for vaccine development and response monitoring, and challenges with immunosuppression.
Multiple issues need to be addressed in order to optimize the benefits offered by breast cancer vaccines. Primary issues include the following: (1) cancer vaccines will likely work better in a minimal residual disease state, (2) clinical trial design for immunotherapy should incorporate recommendations from expert groups such as the Cancer Vaccine Working Group and use standardized immune response measurements, (3) the presently available cancer vaccine approaches, including dendritic cell-based, tumor-associated antigen peptide-based, and whole cell-based, have various pros and cons, (4) to date, no one approach has been shown to be superior to another, and (5) vaccines will need to be combined with immunoregulatory agents to overcome tumor-related immunosuppression.
Combining a properly optimized cancer vaccine with novel immunomodulating agents that overcome tumor-related immunosuppression in a well-designed clinical trial offers the best hope for developing an effective breast cancer vaccine strategy.
利用免疫反应来治疗乳腺癌可能提供一种毒性更小、更有针对性的方法来消除残留疾病。正在开发乳腺癌疫苗，以有效地训练细胞毒性 T 细胞识别和杀死转化细胞，同时保留正常细胞。然而，由于已建立的癌症具有抑制和逃避免疫反应的能力，实现这一目标一直存在问题。
对疫苗和乳腺癌治疗的文献进行了综述，特别针对当前可用的策略，以及适当的设置、疫苗开发和反应监测的范例，以及免疫抑制的挑战。
为了优化乳腺癌疫苗提供的益处，需要解决多个问题。主要问题包括以下几点：（1）癌症疫苗在微小残留疾病状态下可能效果更好，（2）免疫疗法的临床试验设计应纳入癌症疫苗工作组等专家组的建议，并使用标准化的免疫反应测量，（3）目前可用的癌症疫苗方法，包括基于树突状细胞的、基于肿瘤相关抗原肽的和基于整个细胞的，具有各种优缺点，（4）迄今为止，没有一种方法被证明优于另一种方法，（5）疫苗需要与免疫调节剂联合使用，以克服与肿瘤相关的免疫抑制。
在精心设计的临床试验中，将适当优化的癌症疫苗与新型免疫调节药物相结合，为开发有效的乳腺癌疫苗策略提供了最大的希望。
