Immunotherapy for breast cancer

概述

Immunotherapy for breast cancer uses medicines that help your immune system fight cancer. You also may hear it called immune therapy or immuno therapy.

The main type of immunotherapy medicine used for breast cancer is called an immune checkpoint inhibitor. Immune checkpoint inhibitors block signals that cancer cells use to stay hidden from the immune system. This helps the immune system find and destroy cancer cells.

Immunotherapy is not used to treat every type or stage of breast cancer. It is most often used for triple-negative breast cancer. This type of breast cancer does not respond to some medicines used to treat other types of breast cancer. Whether immunotherapy is an option depends on the stage of the cancer, test results, treatments you've already had and your overall health.

Immunotherapy is one of several treatments for breast cancer. Other treatments include chemotherapy and targeted therapy. Each treats cancer in a different way.

• Immunotherapy uses medicines that help your immune system find and destroy cancer cells. It is used for certain people with triple-negative breast cancer.
• Chemotherapy uses medicines that kill fast-growing cells, including cancer cells.
• Targeted therapy uses medicines that target changes in cancer cells that help cancer grow. This helps stop the cancer from growing and spreading.

Learn more about breast cancer diagnosis and treatment.

Types

Types of immunotherapy used or being studied for breast cancer include:

• Immune checkpoint inhibitors. These medicines help the immune system find and attack cancer cells by blocking signals that cancer cells use to stay hidden. Pembrolizumab (Keytruda) is an immune checkpoint inhibitor. This medicine is approved by the Food and Drug Administration (FDA) for certain types of breast cancer. These include high-risk early-stage triple-negative breast cancer and metastatic triple-negative breast cancer.
• Cancer vaccines. These vaccines are designed to help the immune system recognize and attack breast cancer cells. They are still being studied in clinical trials and are not standard treatment for breast cancer.
• Cell-based therapies. Chimeric antigen receptor (CAR)-T cell therapy is one example of cell-based therapy. CAR-T cell therapy changes a person's immune system cells in a laboratory so that they can better find and attack cancer cells. Another example is tumor-infiltrating lymphocyte (TIL) therapy, which uses immune system cells that have already entered a tumor to help fight the cancer. These treatments are still being studied and are available through clinical trials.

Researchers continue to study newer immunotherapy medicines and new ways to combine immunotherapy with targeted therapy, chemotherapy, radiation therapy and other cancer treatments.

Learn more about CAR-T cell therapy.

目的

Immunotherapy may be recommended to help control advanced triple-negative breast cancer that cannot be removed with surgery or has spread to other parts of the body. It also may help lower the risk that high-risk early-stage triple-negative breast cancer comes back after treatment. Depending on the type and stage of the cancer, immunotherapy may be given with chemotherapy before surgery, continued after surgery or combined with another cancer medicine.

Immunotherapy and chemotherapy

Immunotherapy does not usually replace chemotherapy for breast cancer. Instead, the two treatments often are given together. For some people with high-risk early-stage triple-negative breast cancer, pembrolizumab is given with chemotherapy before surgery and then continued after surgery.

For some people with advanced triple-negative breast cancer, pembrolizumab may be combined with chemotherapy or another cancer medicine. Together, these treatments may work better than chemotherapy alone. They also may increase the risk of side effects.

Immunotherapy and targeted therapy

Immunotherapy helps your immune system find and destroy cancer cells, while targeted therapy targets changes in cancer cells that help cancer grow. Healthcare professionals sometimes recommend both treatments together.

Immunotherapy and radiation therapy

Immunotherapy and radiation therapy treat cancer in different ways. Immunotherapy works throughout the body. Radiation therapy treats cancer in specific areas of the body. Healthcare professionals sometimes recommend both treatments together.

Triple-negative breast cancer

For some people with high-risk stage 2 or stage 3 triple-negative breast cancer, pembrolizumab may be given with chemotherapy before surgery and then continued after surgery. In a large clinical trial, this treatment helped people live longer without their cancer getting worse or coming back. It also helped people live longer than chemotherapy alone.

For some people with advanced triple-negative breast cancer, healthcare professionals may order tests to see whether immunotherapy is likely to help. A combination of two medicines, sacituzumab govitecan and pembrolizumab, may be given as a first treatment option for some people with advanced triple-negative breast cancer.

Other breast cancer subtypes

• Hormone receptor-positive breast cancer. This type of breast cancer grows in response to the hormones estrogen or progesterone. It includes estrogen receptor (ER)-positive breast cancer, progesterone receptor (PR)-positive breast cancer or both. Immunotherapy is not a standard treatment for this type of breast cancer.
• Human epidermal growth factor receptor 2 (HER2)-positive breast cancer. This type of breast cancer has high amounts of a protein called HER2, which helps cancer cells grow. HER2-targeted medicines remain the main treatment.
• Metaplastic breast cancer. This is a rare type of breast cancer. The cancer cells look different from the cells found in most breast cancers. It often is triple-negative cancer. Immunotherapy may be an option for some people, but more research is needed to understand how well it works for this type of breast cancer.

Breast cancer that has spread to the brain

Immunotherapy may be part of treatment for some people with triple-negative breast cancer that has spread to the brain. Surgery or radiation therapy also may be needed to treat tumors in the brain.

风险

The main risks of immunotherapy are side effects. Your risk depends on the immunotherapy medicine you receive and whether you also receive chemotherapy or another cancer treatment.

Common side effects of some immunotherapy medicines include tiredness, rash and diarrhea. Hair loss is not a typical side effect of pembrolizumab. But many chemotherapy medicines given with pembrolizumab can cause hair loss. People who receive both treatments may lose some or all of their hair. Ask your healthcare professional which medicine is most likely to cause each side effect.

Side effects may happen during treatment or after treatment ends. They can be serious or, rarely, life-threatening. Some immunotherapy medicines can cause the immune system to attack healthy organs.

• Lungs. A new cough, chest pain or shortness of breath may be signs or symptoms of lung inflammation, called pneumonitis.
• Intestines. Frequent diarrhea, blood or mucus in the stool or severe belly pain may be signs of inflammation of the intestines, called colitis.
• Liver. Yellowing of the skin or eyes, dark urine, nausea or pain on the right side of the belly may be signs of liver inflammation, called hepatitis.
• Hormone glands. Inflammation of the thyroid, pituitary gland, adrenal glands or pancreas can cause unusual tiredness, headache, dizziness, weight changes, increased thirst or changes in urination. Some hormone issues can be permanent.
• Other organs. Inflammation can affect the kidneys, heart, skin, muscles, nerves, eyes and other organs.

Contact your care team right away

Contact your care team right away if your side effects get worse, even if they seem mild or if they happen after immunotherapy has ended. Also contact the care team if you have new side effects. Early treatment of side effects can help prevent serious complications.

如何进行准备

Before treatment, your care team reviews the type and stage of the cancer, test results, previous treatments, medicines and overall health. For advanced triple-negative breast cancer, testing may include a PD-L1 test. This test looks for a protein that may help show whether immunotherapy is likely to work. You also may have blood tests to check your blood cell counts and how well your liver, kidneys and thyroid are working.

Tell your healthcare professional about autoimmune disease, an organ or stem cell transplant, lung or liver disease, pregnancy, breastfeeding and all medicines or supplements you take. Ask whether you need reliable birth control and when pregnancy is safe after treatment. Do not stop prescription medicines unless your healthcare professional tells you to.

可能出现的情况

Knowing what happens before, during and after immunotherapy can help you prepare for treatment. Your care team explains your treatment plan, what to expect at each visit, and which side effects or symptoms to tell them about.

Before the procedure

Immunotherapy for breast cancer usually is given in an infusion center. A healthcare professional checks your symptoms and vital signs and may review blood test results before each dose. Treatment may be delayed if tests or symptoms suggest an infection, organ inflammation or another serious issue.

During the procedure

A healthcare professional places an intravenous line in a vein or uses an implanted port. Pembrolizumab is given as an intravenous infusion. When chemotherapy or another medicine is part of the plan, it may be given during the same visit in a scheduled order. The length and frequency of visits depend on the treatment plan.

Learn more about chemotherapy for breast cancer.

After the procedure

Most people go home after an outpatient infusion. Your care team tells you which symptoms to watch for and when to have blood tests or imaging. Some side effects begin days or weeks after a dose. Immune system-related side effects can appear after treatment has stopped.

Treatment continues for a planned number of doses or until the cancer grows, side effects become too serious or the treatment plan changes. For early-stage triple-negative breast cancer, pembrolizumab is given with chemotherapy before surgery and then continued after surgery.

Learn more about radiation therapy for breast cancer.

结果

Immunotherapy does not work for everyone. It does not cure all breast cancers. For early-stage triple-negative breast cancer, the goal may be to shrink the tumor before surgery and lower the risk of the cancer coming back. For some people, treatment may remove all signs of cancer. Tests on tissue removed during surgery may show that no invasive cancer remains in the breast or nearby lymph nodes. Invasive cancer is cancer that has grown into nearby breast tissue. This is called a pathologic complete response.

For advanced breast cancer, the goals usually are to shrink or control the cancer, relieve symptoms and help people live longer. Imaging tests may show that tumors become smaller, stay the same size or grow. Your healthcare professional uses these results, along with your side effects, treatment goals and preferences, to decide whether treatment should continue or change.

Clinical trials

Research on immunotherapy for breast cancer is ongoing and continues to expand. Clinical trials study new medicines, new treatment combinations and new uses for immunotherapy.

Studies are evaluating immunotherapy for different types and stages of breast cancer. Researchers also are studying new ways to combine immunotherapy with chemotherapy, targeted therapy and radiation therapy.

Other clinical trials test cancer vaccines, cell-based therapies and treatments for breast cancer that has spread to the brain.

Ask your oncology care team whether a clinical trial may be appropriate for you.

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。