Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response
Triple negative breast cancer (TNBC) represents an aggressive disease associated with a high risk of recurrence after curative treatment and a poor prognosis in the metastatic setting. Chemotherapy was for years the only treatment available in the early and metastatic setting, due to the lack of act...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Open Exploration Publishing Inc.
2024-02-01
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| Series: | Exploration of Targeted Anti-tumor Therapy |
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| Online Access: | https://www.explorationpub.com/Journals/etat/Article/1002215 |
| _version_ | 1827339599488221184 |
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| author | Pierluigi De Santis Martina Perrone Chiara Guarini Anna Natalizia Santoro Carmelo Laface Daniela Carrozzo Gaia Rachele Oliva Palma Fedele |
| author_facet | Pierluigi De Santis Martina Perrone Chiara Guarini Anna Natalizia Santoro Carmelo Laface Daniela Carrozzo Gaia Rachele Oliva Palma Fedele |
| author_sort | Pierluigi De Santis |
| collection | DOAJ |
| description | Triple negative breast cancer (TNBC) represents an aggressive disease associated with a high risk of recurrence after curative treatment and a poor prognosis in the metastatic setting. Chemotherapy was for years the only treatment available in the early and metastatic setting, due to the lack of actionable targets. Clinical practice has changed following the results obtained with the addition of immunotherapy to standard chemotherapy, the development of novel drugs [i.e. antibody-drug conjugates (ADCs)], and the use of targeted treatments for patients carrying germline pathogenic breast cancer susceptibility genes (BRCA) 1 or BRCA 2 variants. The treatment of early-stage disease has had a shift in clinical practice since July 2021, after the Food and Drug Administration (FDA) approval of pembrolizumab in association with chemotherapy as neoadjuvant treatment for TNBC and as a single agent in the subsequent adjuvant setting. This intensive treatment based on the combination of a poly-chemotherapy and an immune checkpoint inhibitor (ICI) led to the improvement of short- and long-term outcomes, but it has highlighted some new unmet clinical needs in the treatment of early-stage TNBC: the selection of the most effective adjuvant therapy and the integration of pembrolizumab with other therapeutic strategies [capecitabine, poly(ADP-ribose) polymerase (PARP) inhibitors] based on the achievement of pathologic complete response (pCR); the identification of predictive biomarkers to select patients who could most benefit from the addition of ICI, to minimize toxicities and to maximize outcomes; the possibility of de-escalating chemotherapy in favor of immune-combo or novel agents, such as ADCs; the role of immunotherapy in estrogen receptor (ER)-low patients. The advent of immunotherapy not only addresses current challenges in TNBC treatment but also holds the promise of a radical transformation in its therapeutic paradigm, enhancing significantly clinical outcomes and offering new perspectives for patients grappling with this aggressive form of breast cancer. |
| first_indexed | 2024-03-07T20:01:58Z |
| format | Article |
| id | doaj.art-3fd668f26537425d86bf62f63c98a195 |
| institution | Directory Open Access Journal |
| issn | 2692-3114 |
| language | English |
| last_indexed | 2024-03-07T20:01:58Z |
| publishDate | 2024-02-01 |
| publisher | Open Exploration Publishing Inc. |
| record_format | Article |
| series | Exploration of Targeted Anti-tumor Therapy |
| spelling | doaj.art-3fd668f26537425d86bf62f63c98a1952024-02-28T06:45:10ZengOpen Exploration Publishing Inc.Exploration of Targeted Anti-tumor Therapy2692-31142024-02-015123225010.37349/etat.2024.00215Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete responsePierluigi De Santis0Martina Perrone1Chiara Guarini2Anna Natalizia Santoro3Carmelo Laface4Daniela Carrozzo5Gaia Rachele Oliva6Palma Fedele7https://orcid.org/0000-0002-7437-4676Oncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyOncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyOncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyOncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyOncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyOncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyDepartment of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, ItalyOncology Unit, Francavilla Fontana Ceglie Messapica Hospital District, 72021 Francavilla Fontana, ItalyTriple negative breast cancer (TNBC) represents an aggressive disease associated with a high risk of recurrence after curative treatment and a poor prognosis in the metastatic setting. Chemotherapy was for years the only treatment available in the early and metastatic setting, due to the lack of actionable targets. Clinical practice has changed following the results obtained with the addition of immunotherapy to standard chemotherapy, the development of novel drugs [i.e. antibody-drug conjugates (ADCs)], and the use of targeted treatments for patients carrying germline pathogenic breast cancer susceptibility genes (BRCA) 1 or BRCA 2 variants. The treatment of early-stage disease has had a shift in clinical practice since July 2021, after the Food and Drug Administration (FDA) approval of pembrolizumab in association with chemotherapy as neoadjuvant treatment for TNBC and as a single agent in the subsequent adjuvant setting. This intensive treatment based on the combination of a poly-chemotherapy and an immune checkpoint inhibitor (ICI) led to the improvement of short- and long-term outcomes, but it has highlighted some new unmet clinical needs in the treatment of early-stage TNBC: the selection of the most effective adjuvant therapy and the integration of pembrolizumab with other therapeutic strategies [capecitabine, poly(ADP-ribose) polymerase (PARP) inhibitors] based on the achievement of pathologic complete response (pCR); the identification of predictive biomarkers to select patients who could most benefit from the addition of ICI, to minimize toxicities and to maximize outcomes; the possibility of de-escalating chemotherapy in favor of immune-combo or novel agents, such as ADCs; the role of immunotherapy in estrogen receptor (ER)-low patients. The advent of immunotherapy not only addresses current challenges in TNBC treatment but also holds the promise of a radical transformation in its therapeutic paradigm, enhancing significantly clinical outcomes and offering new perspectives for patients grappling with this aggressive form of breast cancer.https://www.explorationpub.com/Journals/etat/Article/1002215triple negative breast cancerimmunotherapypathological complete responseneoadjuvant combination treatmentadjuvant treatment |
| spellingShingle | Pierluigi De Santis Martina Perrone Chiara Guarini Anna Natalizia Santoro Carmelo Laface Daniela Carrozzo Gaia Rachele Oliva Palma Fedele Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response Exploration of Targeted Anti-tumor Therapy triple negative breast cancer immunotherapy pathological complete response neoadjuvant combination treatment adjuvant treatment |
| title | Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response |
| title_full | Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response |
| title_fullStr | Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response |
| title_full_unstemmed | Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response |
| title_short | Early-stage triple negative breast cancer: the therapeutic role of immunotherapy and the prognostic value of pathological complete response |
| title_sort | early stage triple negative breast cancer the therapeutic role of immunotherapy and the prognostic value of pathological complete response |
| topic | triple negative breast cancer immunotherapy pathological complete response neoadjuvant combination treatment adjuvant treatment |
| url | https://www.explorationpub.com/Journals/etat/Article/1002215 |
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