South Florida Hospital News
Tuesday September 17, 2019
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October 2015 - Volume 12 - Issue 4

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Immunotherapy of Breast Cancer

Harnessing the Power of Immune System
 
Breast cancer is the most common malignancy among women world-wide. By using cancer screening methods breast cancer can be diagnosed early and treated with standard methods including surgery, chemotherapy, targeted therapy, radiation therapy, and hormone therapy with a great deal of success. A recent analysis published in Journal of Clinical Oncology demonstrated that risk of breast cancer-specific death declined over the period from 1973-2010 independent from tumor size and hormone receptor status, suggesting a crucial role for treatment. Unfortunately, despite improved treatments breast cancer is still one of the leading causes of mortality in women. Therefore, new therapeutic strategies for breast cancer are needed to improve clinical outcomes for breast cancer patients, particularly those with advanced disease.
 
Immune cells function as a surveillance system by eradicating transforming cells that may potentially progress into cancer. Studies have shown that augmenting patients’ own immune systems can induce an anti-cancer activity and neutralize malignant cells.
 
Immunotherapy has emerged as a novel therapeutic strategy for solid malignancies; and being effectively used in melanoma, prostate and lung cancer as a standard treatment.
 
With the exception of trastuzumab and pertuzumab, two agents that target HER-2 receptor, breast cancer treatment currently does not involve immunotherapy among standard treatment options. Therefore, patients with breast cancer have had limited access to immunotherapies outside the clinical trials. Currently, immunotherapy is being investigated in early as well as advanced stages. The emerging role of immunotherapy in breast cancer was demonstrated by several presentations at the San Antonio Breast Cancer Symposium in 2014 and American Society of Clinical Oncology Meeting in 2015.
 
There are multiple immunotherapy methods that are being used. Immune system physiologically regulates itself and limits the magnitude of the immune response by utilizing checkpoints. These checkpoint receptors are CTLA-4, PD-1 and PD-L1. Cancer cells can exploit these checkpoints and evade the immunity. Checkpoint inhibitors block these inhibitory molecules and enhance pre-existing anti-cancer immune responses. Agents that are being actively used in other solid tumors such as Ipilimumab, Nivolumab, Pembrolizumab or novel agents such as Pidilizumab, MPDL3280A are being investigated in clinical trials of various phases.
 
A vaccine is a portion of a pathogen which, after injection, promotes the formation of a specific adaptive immunity. Active immunization strategies that have proved successful for prophylactic vaccines against infections are being utilized in an effort to harness the natural immune response to malignancies. Cancer vaccines are designed to stimulate an immune response against tumor- associated antigens, programming the immune system to destroy cancer cells harboring these antigens. Today, cancer has become another frontline for vaccine based therapies. Several trials of vaccines are currently enrolling breast cancer patients.
 
The adoptive T-cell therapy is considered another powerful immune-based treatment option that may potentially produce a durable immune response against cancer cells. In this approach, T lymphocytes are removed from a patient, genetically engineered or activated by incubating them with antigens from cancer cells then re-introduced into the patient to recognize and destroy malignant cells. Several phase I and II trials of adoptive T cell transfer techniques are currently ongoing for patients with breast cancer.
 
In the near future, as the clinical trials progress there will be an explosion of data, knowledge and new technologies in the cancer immunotherapy field. Biomarker research will allow us to predict responses to immunotherapy. Ability to analyze the tumors and mutations at the molecular level will help us to identify tumors that would benefit from immunotherapy. Hopefully all these developments will help us to individualize therapy by selecting optimal treatment for each patient.
Dr. Mehmet F. Hepgur, Broward Health Physician Group, can be reached at mhepgur@browardhealth.org or call (954) 355-4975.
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