[Evaluation of the immune infiltrate in breast cancer]

Tumour-infiltrating lymphocytes (TIL) are major components of the immune/"inflammatory" infiltrate found in tumour microenvironment. They reflect the intensity and the quality of the immune reaction to cancer. In breast cancer, TIL density and phenotypic profile have been demonstrated to be predictive of response to neoadjuvant treatment and of patient outcome. TIL density, currently the best-developed TIL-related biomarker, is defined as the percentage of tumour stroma surface occupied by TIL. The baseline TIL density of 50% and higher is associated with particularly high rates of pathological complete response to neoadjuvant therapy in triple negative and HER2+ breast cancer, as well as with significantly better recurrence-free and overall survival. Similar predictive and prognostic value has been demonstrated for the ratio between the numbers of CD8+ and FoxP3+ TIL. TIL density and the CD8+/FoxP3+ ratio are promising biomarkers in breast cancer, which could be used in tailoring of neoadjuvant and adjuvant systemic therapy and in selection of patients for different immunotherapy modalities. This article reviews elements of the immune response to cancer, methods of TIL analysis, evidence of TIL' prognostic and predictive value in the current breast cancer management as well as the perspectives for use of TIL' characteristics as biomarkers in breast cancer immunotherapy.