This article reviews the principal attempts of immune-modulation or immune therapy
in metastatic breast cancer. It considers their rationale and reports on results from the
relevant key clinical trials. Immune-modulatory or immune-stimulating cytokines used alone
or combined with conventional therapies is among the principal approaches of immune manipulation
in breast cancer. As this issue has recently been reviewed by us, the aim of the current
article is to discuss our updated and unpublished data on this topic. Overall survival in
luminal (28 patients) and non-luminal (9 patients) molecular subtypes is 91 and 59 months
respectively that is about two and half or three times longer than expected. Thereafter, we focus
on monoclonal antibodies (mAb) based-therapies including novel strategies to overcome
resistance to anti-HER2 mAb. The main vaccine platforms in different molecular subtypes
and immune therapies in triple negative metastatic breast cancer (m-TNBC) are discussed in
the last sections. Some phase III investigations have already changed the current clinical practice.
In fact, pertuzumab plus trastuzumab and docetaxel is the recommended first line regimen
in HER2 positive locally recurrent or metastatic breast cancer and bevacizumab plus paclitaxel
or docetaxel is a reasonable option for m-TNBC. In some other observational or phase
I/II studies on first-line trastuzumab plus chemotherapy and hormonal therapy and in that on
HER2 peptide/protein vaccines promising although preliminary findings have been reported
to be further validated. In the remaining studies, results were disappointing. In the future,
finding new predictive biomarkers and exploring more suitable synergizing combinations,
time and dose-dependent-scheduled sequences of currently and further investigated immunological
approaches are main challenges.
Keywords: Immunotherapy, breast cancer, cytokines, mAb, m-TNBC, interferons.
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