Division of Medical Oncology, National Cancer Center Singapore, Singapore.
Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore.
Curr Opin Oncol. 2020 Nov;32(6):575-584. doi: 10.1097/CCO.0000000000000675.
Breast cancer is a relative latecomer in the success story of immuno-oncology. In this review, we focus on the preclinical and clinical lines of evidence to justify the evaluation of immune checkpoint inhibition (ICI) for the curative-intent treatment of breast cancer, the latest and ongoing trials of (neo)adjuvant immunotherapy, and practical considerations in clinical practice associated with this new treatment paradigm.
Insights from the immunobiology of breast cancer have paved the way for the new frontier of immunotherapy in this malignancy, starting from advanced stages and moving onto curable cases. Tumor-infiltrating lymphocyte quantification and PD-L1 immunohistochemistry are forerunners of predictive biomarkers for sensitivity to ICI in breast cancers. Preliminary results from phase III trials of combinatorial immunochemotherapy to treat early high-risk or locally advanced triple-negative breast cancer are encouraging for pathological complete response. Additional efficacy and patient-reported outcomes of (neo)adjuvant immunochemotherapy trials are awaited.
The prospect of integrating ICI in the treatment of early-stage breast cancer is promising. Questions regarding patient selection, the choice of ICI agent and combination partner in escalation strategies, sequencing and duration of treatments, cost-effectiveness and mechanisms of resistance remain to be answered by future research.
乳腺癌是肿瘤免疫治疗成功故事中的后来者。在这篇综述中，我们重点关注临床前和临床证据，以证明免疫检查点抑制（ICI）用于乳腺癌的治愈性治疗的评估，最新和正在进行的新辅助免疫治疗试验，以及与这种新治疗模式相关的临床实践中的实际考虑。
乳腺癌的免疫生物学见解为该恶性肿瘤的免疫治疗新领域铺平了道路，从晚期开始，进而扩展到可治愈的病例。肿瘤浸润淋巴细胞定量和 PD-L1 免疫组化是预测乳腺癌对 ICI 敏感性的生物标志物。联合免疫化疗治疗早期高危或局部晚期三阴性乳腺癌的 III 期试验的初步结果令人鼓舞，可达到病理完全缓解。正在等待新辅助免疫化疗试验的额外疗效和患者报告结果。
将 ICI 纳入早期乳腺癌治疗的前景很有希望。未来的研究仍需回答有关患者选择、递增策略中 ICI 药物和联合治疗伙伴的选择、治疗的顺序和持续时间、成本效益以及耐药机制等问题。
