Kumar Sudhir, Pezo Rossanna C
Division of Medical Oncology and Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Curr Oncol. 2025 Jun 26;32(7):373. doi: 10.3390/curroncol32070373.
Immunotherapy has a defined role in the treatment of both early- and late-stage triple-negative breast cancer (TNBC) and is under active exploration in human epidermal receptor 2-positive as well as high-risk hormone-receptor-positive subtypes. It is critical to balance the efficacy and toxicity of immunotherapy while keeping the cost and duration of treatment in check. In addition to the immunohistochemistry testing of PD-L1 expression, which only predicts the efficacy of immunotherapy in metastatic TNBC, there is a lack of biomarkers that are better standardized to predict efficacy and treatment response, detect early relapse, and guide prognosis in breast cancer patients treated with immunotherapy. Circulating tumor DNA (ctDNA) is a minimally invasive, dynamic, real-time, blood-based biomarker that has shown promising value in the management of solid tumors, including breast cancer. This review discusses the emerging evidence for the potential application of ctDNA to further refine patient-centered care and personalize treatment based on a molecularly defined risk assessment for breast cancer patients treated with immunotherapy-based approaches. We further discuss the challenges and barriers to widespread adoption of this promising tool in the management of breast cancer patients requiring immunotherapy.
免疫疗法在早期和晚期三阴性乳腺癌（TNBC）的治疗中具有明确作用，并且正在对人表皮受体2阳性以及高危激素受体阳性亚型进行积极探索。在控制治疗成本和疗程的同时，平衡免疫疗法的疗效和毒性至关重要。除了仅能预测转移性TNBC中免疫疗法疗效的PD-L1表达免疫组化检测外，缺乏更好标准化的生物标志物来预测疗效和治疗反应、检测早期复发以及指导接受免疫疗法治疗的乳腺癌患者的预后。循环肿瘤DNA（ctDNA）是一种微创、动态、实时的血液生物标志物，在包括乳腺癌在内的实体瘤管理中已显示出有前景的价值。本综述讨论了ctDNA潜在应用的新证据，以基于对接受免疫疗法治疗的乳腺癌患者进行分子定义的风险评估，进一步优化以患者为中心的护理并实现个性化治疗。我们还讨论了在需要免疫疗法的乳腺癌患者管理中广泛采用这一有前景工具的挑战和障碍。
