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An exclusive “Ask the Expert” Q&A session with the esteemed medical oncologist from Memorial Sloan Kettering Cancer Center, Dr. Tiffany Traina, a luminary in the field of oncology, particularly in the battle against TNBC.
Below is a summary of the discussion with Dr. Traina.
Immunotherapy has become a promising approach in treating triple-negative breast cancer (TNBC), especially for patients lacking hormone receptor targets. This type of treatment leverages the body’s immune system to identify and destroy cancer cells more effectively. Here’s how it works, why it’s impactful, and how to know if you might be a candidate.
How Immunotherapy Works in TNBC
The body’s immune system typically attacks foreign cells, like infections, but is also programmed to regulate its intensity to avoid harming healthy organs. In cancer, the immune system often doesn’t recognize cancer cells as threats, allowing them to grow unchecked. Immunotherapy boosts the immune system’s ability to recognize and destroy these cancer cells by removing some of its natural brakes. A key drug, pembrolizumab, FDA-approved for breast cancer, inhibits the body’s braking mechanism, allowing immune cells, like T-cells, to attack cancer more aggressively.
However, this boost can lead to autoimmune side effects, where the immune system may attack healthy tissue, causing issues like arthritis, hepatitis, lung inflammation, or skin rashes. This effect mirrors diseases rheumatologists treat, showing how immunotherapy can prompt the immune system to go into overdrive.
Why Immunotherapy Works Best with Other Treatments
When combined with chemotherapy or radiation, immunotherapy is particularly effective. These treatments kill cancer cells, releasing bits of cellular debris that alert the immune system to potential threats, thus strengthening the immunotherapy response. On its own, immunotherapy is less active, but pairing it with chemotherapy or radiation helps maximize its impact.
Who Is a Candidate for Immunotherapy in TNBC?
Early-Stage TNBC: Candidates for immunotherapy in early-stage TNBC don’t require specific biomarkers but must meet criteria related to tumor size (over 2 centimeters) or lymph node involvement. Immunotherapy in these cases is typically combined with preoperative chemotherapy.
Metastatic TNBC: In metastatic cases, immunotherapy is most effective as a first-line treatment combined with chemotherapy, specifically for patients whose tumors are PD-L1 positive. This is determined through testing the tumor for PD-L1 levels, with a score of 10 or higher indicating a good response to immunotherapy. About 40% of metastatic TNBC cases test PD-L1 positive.
Takeaways
Immunotherapy has brought new hope to many TNBC patients, especially when paired with other treatments. For anyone diagnosed with TNBC, discussing immunotherapy as an option with a healthcare provider can be crucial, especially in understanding if PD-L1 testing or tumor size criteria apply. This combination of cutting-edge treatments is helping to redefine cancer care and offering brighter outcomes for patients battling TNBC.
