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Triple negative breast cancer - prognostic role of immune-related factors: a systematic review
Elisabeth Specht Stovgaard1, Dorte Nielsen2, Estrid Hogdall3
1a Deparment of Pathology , Herlev and Gentofte Hospital, University of Copenhagen , Herlev , Denmark.
Purpose:
Treatment of breast cancer has been increasingly successful in recent years with the advent of HER2-receptor targeted treatment and endocrine treatment. However, the triple negative subgroup of breast cancer (TNBC) (estrogen-, progesterone- and HER2-receptor negative) still lacks targeted treatment options. TNBC is a type of breast cancer that often affects younger women, and generally has a worse prognosis than other types of breast cancer. Recently, the complex role of the immune system in cancer growth, elimination and metastasis has been the object of increased attention. There is hope that a more detailed understanding of the intricate roles of the constituents of the immune system, will hold potential both as prognostic or predictive markers of cancer progression, but also as treatment targets for a wide range of tumors, including TNBC. The aim of this review is to provide an overview of the cellular immune microenvironment in TNBC, and to highlight areas in which TNBC may differ from other types of breast cancer.
Material And Methods:
A search of PubMed was made using the terms 'triple negative breast cancer' and 'tumor infiltrating lymphocytes', 'CD8', 'CD4', 'B cells', 'natural killer cells', 'macrophages', myeloid derived suppressor cells', 'dendritic cells', 'immune check point inhibitor', 'CTLA-4' and 'PD-L1'.
Results:
We find that whilst factors such as TILs and certain subgroups of TILs (e.g., CD8 + and regulator T-cells) have been extensively researched, none of these markers are currently applicable to routine clinical practice. Also, TNBC differs from other types of breast cancer with regards to cellular composition of the immune infiltrate and PD-L1 expression, and the prognostic significance of these.
Conclusions:
Immune-related factors have the potential as both prognostic and predictive biomarkers for new treatments targeting the immune system in breast cancer. However, multivariate analyses, taking other well-known factors into account, are required to determine the true value of these biomarkers. Also, differences between TNBC and other types of breast cancer may have implications for treatment and use of immune-related factors as biomarkers.
Insights
Triple-negative breast cancer (TNBC) research shows immune cells like tumor-infiltrating lymphocytes (TILs) are key. While promising, these immune markers need more study for clinical use in TNBC treatment.
Area of Science:
- Immunology
- Oncology
- Genetics
Background:
- Breast cancer treatment has advanced, but triple-negative breast cancer (TNBC) lacks targeted therapies.
- TNBC often affects younger women and has a poorer prognosis.
- The immune system's role in cancer is increasingly recognized as crucial for understanding and treating tumors.
Purpose of the Study:
- To review the cellular immune microenvironment in TNBC.
- To identify how TNBC's immune microenvironment differs from other breast cancer types.
- To explore the potential of immune components as prognostic/predictive markers and therapeutic targets in TNBC.
Main Methods:
- PubMed search using terms: 'triple negative breast cancer', 'tumor infiltrating lymphocytes', 'CD8', 'CD4', 'B cells', 'natural killer cells', 'macrophages', 'myeloid derived suppressor cells', 'dendritic cells', 'immune check point inhibitor', 'CTLA-4', and 'PD-L1'.
- Review of existing literature on the immune microenvironment in TNBC.
Main Results:
- Factors like tumor-infiltrating lymphocytes (TILs) and specific subgroups (e.g., CD8+ T-cells) are researched but not yet clinically applicable.
- TNBC exhibits distinct cellular immune infiltrate composition compared to other breast cancers.
- Differences in PD-L1 expression and its prognostic significance are noted in TNBC.
Conclusions:
- Immune factors hold potential as prognostic and predictive biomarkers for novel breast cancer immunotherapies.
- Further multivariate analyses are needed to validate the clinical utility of these immune biomarkers.
- Distinct immune characteristics of TNBC may influence treatment strategies and biomarker applications.
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