From the University of Pittsburgh Department of Medicine and UPMC Hillman Cancer Center, Pittsburgh, PA.
Cancer J. 2021;27(1):59-66. doi: 10.1097/PPO.0000000000000497.
Triple-negative breast cancer (TNBC) is an aggressive subtype of mammary carcinoma. A subset of TNBC is immune activated, suggesting that immunotherapy may be a viable treatment strategy. Phase III clinical trials have shown that atezolizumab or pembrolizumab is well-tolerated in combination with chemotherapy, with progression-free survival benefit in metastatic programmed death ligand-1 (PD-L1)-positive TNBC patients treated first line. Based on IMpassion130, the combination of atezolizumab and nab-paclitaxel is now considered a standard of care for the treatment of PD-L1-positive advanced TNBC. In early TNBC, pembrolizumab and atezolizumab have been tested in combination with standard neoadjuvant chemotherapy, resulting in a higher complete pathologic response rate than standard neoadjuvant chemotherapy alone, regardless of disease PD-L1 status. These findings establish proof of principle for immunotherapy in both early and advanced TNBC. High priorities for the field include developing more active immunotherapy combination regimens and more refined biomarkers that optimally identify patients most likely to benefit from immunotherapy.
三阴性乳腺癌（TNBC）是一种侵袭性的乳腺肿瘤亚型。TNBC 的一个亚组具有免疫激活特征，提示免疫疗法可能是一种可行的治疗策略。III 期临床试验表明，阿替利珠单抗或帕博利珠单抗联合化疗在转移性程序性死亡配体-1（PD-L1）阳性 TNBC 患者中具有良好的耐受性，一线治疗可带来无进展生存期获益。基于 IMpassion130 研究，阿替利珠单抗联合白蛋白紫杉醇已被认为是 PD-L1 阳性晚期 TNBC 的治疗标准。在早期 TNBC 中，帕博利珠单抗和阿替利珠单抗已与标准新辅助化疗联合进行了测试，无论疾病 PD-L1 状态如何，与单纯标准新辅助化疗相比，完全病理缓解率更高。这些发现为早期和晚期 TNBC 的免疫治疗确立了原理证明。该领域的当务之急包括开发更有效的免疫治疗联合方案和更精确的生物标志物，以最佳识别最有可能从免疫治疗中获益的患者。
