Checkpoint Blockade Strategies in the Treatment of Breast Cancer: Where We Are and Where We Are Heading

Abstract

Immunotherapy has become one of the greatest advances in medical oncology over the last century; however, the optimal application for the treatment of breast cancer remains an active area of investigation. Modern immunotherapy strategies augment the immune system and ideally, permit durable tumor-specific immune memory. In fact, several monoclonal antibodies that mediate the immune checkpoint receptors have provided the most clinically meaningful improvement for breast cancer patients to date, particularly for the triple negative subtype. Checkpoint blockade as monotherapy has demonstrated some encouraging results, although some combination strategies appear to augment those responses and may be particularly effective when administered earlier in the course of disease. For example, the combination of atezolizumab and nab-paclitaxel as first-line therapy for metastatic triple negative breast cancer demonstrated significant improvements in progression-free survival when compared with chemotherapy alone. Herein, we review the data for immune therapy in breast cancer and highlight promising future directions.

Keywords: Atezolizumab; Avelumab; BRCA1/2 mutations; Breast cancer; CTLA-4; Durvalumab; HER2 positive breast cancer; Hormone receptor-positive breast cancer; Immune checkpoint inhibitors; Immunotherapy; Ipilimumab; Nivolumab; PARP inhibitors; PD-L1; PD1; Pembrolizumab; Triple negative breast cancer; Tumor-infiltrating lymphocytes.