[Role of chemotherapy in adjuvant treatment of breast cancer: modulation of the immune status]

Abstract

Adjuvant antimitotic chemotherapy increases the survival rates of patients suffering from breast cancer with nodes involvement, but its effects on the immune status are still unclear. The immune status of these patients was studied from the general point of view and particularly from the antitumoral immunity. The most studies which have been made, indicated a such immunity was present, and proved it was more important when the tumor's invasiveness is limited without node involvement. From a general point of view, when an immunologic impairment is present in patients with breast cancer, it seems to have a poor prognosis. Many modulations of this immune status are determined by the treatment's modalities: surgery and radiotherapy have more or less local or general immunologic effects and in certain conditions, antimitotic chemotherapy is immunosuppressive, but it may also interfere as an immunoregulator with a good effect on antibody secreting cells or on suppressive cells. Several situations may be considered according to the tumor immunogenicity and the host immunologic competence. In these different cases, immunotherapy is not always indicated and when this one is, its specificity is still not sufficient. The recent results of specific or non specific immunotherapy trials performed after locoregional treatment or antimitotic chemotherapy are generally not significant and do not lead us to propose a modulation of immune status without controlled trials.