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April 11, 2019

Current Landscape of Immunotherapy in Breast Cancer: A Review

Author Affiliations
  • 1Perlmutter Cancer Center, NYU School of Medicine, New York, New York
  • 2Laboratory of Tumor Immunology and Biology, National Cancer Institute, Bethesda, Maryland
  • 3Columbia University Medical Center, New York, New York
  • 4Clinical Investigations Branch, Cancer Therapy and Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
  • 5Investigational Drug Branch, Cancer Therapy and Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
  • 6US Food and Drug Administration, Silver Spring, Maryland
  • 7Virginia Commonwealth University, Massey Cancer Center, Richmond
  • 8Cedars-Sinai Medical Center, Los Angeles, California
  • 9Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 10Gemini Group, Ann Arbor, Michigan
  • 11Providence Cancer Institute, Earle A. Chiles Research Institute, Portland, Oregon
  • 12Department of Medicine, Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill
  • 13Coordinating Center for Clinical Trials, National Cancer Institute, Rockville, Maryland
  • 14Genitourinary Malignancy Branch, National Cancer Institute, Bethesda, Maryland
  • 15MD Anderson Cancer Center, Houston, Texas
  • 16British Columbia Cancer Agency, Vancouver, British Columbia, Canada
  • 17The Ohio State University Comprehensive Cancer Center, Columbus
  • 18Montefiore Einstein Center for Cancer Care, New York, New York
  • 19Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 20Editor, JAMA Oncology
  • 21Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 22Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
JAMA Oncol. 2019;5(8):1205-1214. doi:10.1001/jamaoncol.2018.7147

Importance  There is tremendous interest in using immunotherapy to treat breast cancer, as evidenced by the more than 290 clinical trials ongoing at the time of this narrative review. The objective of this review is to describe the current status of immunotherapy in breast cancer, highlighting its potential in both early-stage and metastatic disease.

Observations  After searching ClinicalTrials.gov on April 24, 2018, and PubMed up to June 30, 2018, to identify breast cancer immunotherapy trials, we found that immune checkpoint blockade (ICB) is the most investigated form of immunotherapy in breast cancer. Use of ICB as monotherapy has achieved objective responses in patients with breast cancer, with higher rates seen when administered in earlier lines of therapy. For responding patients, those responses are durable. More recent data suggest clinical efficacy when ICB is given in combination with chemotherapy. Ongoing studies are evaluating combination strategies pairing ICB with additional chemotherapeutic agents, targeted therapy, vaccines, and local ablative therapies to enhance response. To date, robust predictive biomarkers for response to ICB have not been established.

Conclusions and Relevance  It is anticipated that combination therapy strategies will be the way forward for immunotherapy in breast cancer, with an improved understanding of tumor, microenvironment, and host factors informing treatment combination decisions. Thoughtful study design incorporating appropriate end points and correlative studies will be critical in identifying optimal strategies for enhancing the immune response against breast tumors.