Institute of Cancer, Xinqiao Hospital, Army Medical University, Chongqing, China.
Geneplus-Beijing, Beijing, China.
Front Immunol. 2021 Feb 22;12:610149. doi: 10.3389/fimmu.2021.610149. eCollection 2021.
Breast cancer is one of the most commonly diagnosed malignancies. Although endocrine therapy improves the survival of patients with hormone receptor (HR)-positive breast cancer, the post-endocrine therapy strategy for metastatic breast cancer remains challenging. Herein, we report two patients who benefited from antiestrogen agents combined with an immunotherapy regimen to support the notion that an immunotherapy combination regimen may be a potential treatment for patients with HR-positive metastatic breast cancer post-endocrine therapy. Case 1 involved a patient with relapsed breast cancer with ovarian and brain metastases after endocrine therapy. After undergoing surgery for the ovarian lesions, she received three cycles of chemotherapy. Given that the lesions in the brain did not change, chemotherapy was discontinued. A high T cell receptor (TCR) repertoire (high Shannon index and clonality) was observed in the tumor. Considering the patient's preference and safety, and the efficacy of immunotherapy, she was administered with letrozole combined with pembrolizumab. The patient achieved a partial response, and the progression-free survival (PFS) was more than 21 months. Case 2 involved a patient with breast cancer with multiple bone metastases. After failure of combined radiotherapy and chemotherapy, the patient received tamoxifen combined with pembrolizumab based on the patient's preference and clinical biomarkers of a positive differentiation cluster of eight tumor-infiltrating lymphocytes and a high TCR repertoire (high Shannon index and clonality) in the tumor. The patient's bone pain and biomarkers were relieved after the treatment. The patients completed six cycles of pembrolizumab, and the PFS was more than 21 months. In conclusion, our study confirmed that antiestrogen agents combined with an immunotherapy regimen is a promising treatment for patients with HR-positive metastatic breast cancer.
乳腺癌是最常见的恶性肿瘤之一。尽管内分泌治疗改善了激素受体（HR）阳性乳腺癌患者的生存，但转移性乳腺癌的内分泌治疗后策略仍然具有挑战性。在此，我们报告了两例受益于抗雌激素药物联合免疫治疗方案的患者，这支持了免疫治疗联合方案可能是 HR 阳性转移性乳腺癌内分泌治疗后患者的一种潜在治疗方法的观点。
病例 1 涉及一名经内分泌治疗后发生卵巢和脑转移的复发性乳腺癌患者。在接受卵巢病变手术后，她接受了三个周期的化疗。由于脑部病变没有改变，化疗被停止。在肿瘤中观察到高 T 细胞受体（TCR）谱（高 Shannon 指数和克隆性）。考虑到患者的偏好和安全性以及免疫治疗的疗效，给予来曲唑联合 pembrolizumab 治疗。患者获得部分缓解，无进展生存期（PFS）超过 21 个月。
病例 2 涉及一名患有多发性骨转移的乳腺癌患者。在联合放化疗失败后，根据患者的偏好和临床生物标志物，即肿瘤中存在 8 个肿瘤浸润淋巴细胞阳性分化簇和高 TCR 谱（高 Shannon 指数和克隆性），患者接受了他莫昔芬联合 pembrolizumab 治疗。治疗后，患者的骨痛和生物标志物得到缓解。患者完成了 6 个周期的 pembrolizumab 治疗，PFS 超过 21 个月。
总之，我们的研究证实，抗雌激素药物联合免疫治疗方案是 HR 阳性转移性乳腺癌患者有前途的治疗方法。
