Breast cancer: the considerable progress in immunotherapy significantly delays life expectancy, even in the worst prognosis

Breast cancer: the considerable progress in immunotherapy significantly delays life expectancy, even in the worst prognosis

An international study published on July 21 reveals that adding a type of immunotherapy, an antibody called pembrolizumab, to chemotherapy improves the overall survival of patients with advanced triple-negative breast cancer by 27%, a worse prognosis in this type of cancer . Triple negative breast cancer accounts for approximately 15% of all diagnosed breast tumors.

Proof of advances in research and therapies, much has been achieved in 40 years in the treatment of breast cancer. Chemotherapy since the 1970s has shown its ability to improve patient outcomes when applied after surgery. Hormonal treatments have also been added, and more recently, more effective targeted therapies have gradually reduced the impact of breast cancer.

However, there is a type of these cancerous tumors whose weaknesses are unknown, such as the so-called triple negatives, because their cells do not have estrogen or progesterone receptors and produce little HER2, the protein that regulates cell multiplication. They represent around 15% of breast tumors and are more frequent in women under 40 years of age, much more aggressive and with a high risk of poor prognosis.

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On July 21, 2022, the New England Journal of Medicine published the results of a study that offers a new treatment option for these patients. The trial, involving 847 patients, showed that when an immunotherapy drug is given, an antibody called pembrolizumabis added to the usual treatment of these tumors with chemotherapy, the average survival increases seven months in patients with advanced triple negative cancer, from 16 to 23 months.

The study authors report that in patients with advanced triple-negative breast cancer whose tumors express the PD-L1 biomarker, the addition of pembrolizumab to chemotherapy results in significantly longer overall survival than chemotherapy alone. About 40% of triple-negative breast cancer patients have elevated levels of this biomarker.

PD-L1 is a protein that our body uses to identify healthy cells and prevent our own immune system, in addition to eliminating harmful viruses or bacteria, from acting against our own body. This protective function is also used by certain tumor cells. These are authentic poisons in our body, and they go unnoticed by our immune defenses or therapeutic treatments.

Experimental treatments are being tested in people with worse prospects, but researchers say they will offer more benefit in patients with less advanced tumors

Immunotherapeutic treatments, such as monoclonal antibody pembrolizumab, used in this study, are able to remove this mask of cancer and expose it to the immune system. 40% of people with triple negative breast tumors have elevated levels of this biomarker and could benefit from the new treatment.

However, tumor cells can escape this attack by expressing a protein called PD-L1 on their surface. PD-L1 works as a “stop signal” and inactivates T cells before they attack.

Immunotherapy could unmask hidden tumors under the expression of proteins such as PDL1 and increase the efficacy of other drugs.

This union between PD-L1 and its receptors therefore constitutes an interesting therapeutic target for immuno-oncology. In fact, blocking the PD-L1 protein can prevent cancer cells from inactivating T cells through the PD-1 and B7.1 receptors. Thus, T lymphocytes regain their role in the detection and destruction of cancer cells.

In any case, this is revealed by the study carried out by the team of Dr. Cortés, which was published by the New England Journal Of Medicine and validated by its peers.

Still, the increase in seven-month survival recorded in the study “is the largest in the history of triple-negative metastatic breast cancer.”

According to the researchers, the combination of Trojans will be important with immunotherapy. The former are drugs that combine a targeted drug to deliver chemotherapy to the tumor and release the load there with greater intensity and fewer side effects.

The study conducted by Doctor Cortés was published by the New England Journal Of Medicine and validated by his peers. He can be contacted at jacortes@vhio.net or at the International Breast Cancer Center, Marquesa de Vilallonga 12, Barcelona 08017, Spain.

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