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Review
. 2020 Nov;32(6):575-584.
doi: 10.1097/CCO.0000000000000675.

Integrating immunotherapy in the (neo)adjuvant setting of early breast cancer

Jack J Chan  1   2 , Tira J Y Tan  1   2 , Rebecca A Dent  1   2
Affiliations
Review

Integrating immunotherapy in the (neo)adjuvant setting of early breast cancer

Jack J Chan et al. Curr Opin Oncol. 2020 Nov.

Abstract

Purpose of review: 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.

Recent findings: 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.

Summary: 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.

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