Breast cancer has now progressed to the point where it brews great anticipation due to the introduction of new therapies, particularly immunotherapy. Protocols that involve simply boosting the body’s core makeup to search and eliminate the cells forming cancer are standing out. Focusing attention on estrogen or progesterone and how breast cancer tumors are hormone-receptor-positive, breast cancer immunotherapy is multi faceted.
Breast cancer management now at least has some drugs that target hormonal pathways but what if immunotherapy could target the cancer cells while also eliminating the need for hormonal blockade – now that could revolutionize the management of the disease. Not only will it eradicate the targeted tumor cells but having immunotherapy would target the well known side effects associated with the traditional therapies.
This article will discuss the prospects of immunotherapy in patients struggling with hormonal pathways in regards to breast cancer.
Immunotherapy In Breast Cancer Hormone
A large number of human breast cancers express estrogen and/or progesterone receptors and are thus likely to be HR+. HR+ breast cancer is not only the most prevalent breast cancer subtype but is also classified as the target type for immunotherapy. Conventional management has been primarily through hormone therapies aimed at the suppression of such receptors but one can opt for an alternative which is engaging the body immune system specifically immunotherapy to identify and eradicate malignant cells.
Immuno-oncology in HR+ Breast Cancer
- Immune Checkpoint Inhibitors (ICIs): These agents attack PD-1/PD-L1 proteins that malignant neoplasms utilize in order to escape immune surveillance. HR+ However, breast cancer is characterized by the tumor microenvironment with low levels of PD-L1 expression and low immune cell infiltration, suggesting that these types of tumors are “cold” tumors. This explains why the benefits of ICIs in HR+ breast cancer are less convincing than in other types such as triple negative breast cancer.
- Targeting Tumor Microenvironment And Vascularization: Tumors that are HR+ have a deficient tumor immune milieu. Approaches for switching immunologically “cold” tumors into “hot” tumors include the use of immunotherapy with agents that could promote immune cell infiltration and immune activation in the tumor microenvironment as well.
- Immunotherapy and CDK4/6 inhibitors: The tripartite treatment of HR+BCA with immunotherapy and hormone therapy or CDK4/6 inhibitors is being investigated. It has been established that the use of CDK4/6 inhibitors tends to induce CD8+ T cells anti-tumor responses through the upregulation of antigen presentation and downregulation of T regulatory cells, which may enhance the effect of immunotherapy in HR+ breast cancer.
Medical research continues to make notable advances; however, immunosuppression remains one of the most daunting challenges that immunotherapy encounters. Along with unimaginable childhood traumas and PTSD correlations, one of its major faults, as innumerable studies demonstrate, is the significant mortality rate. Immunotherapy seems to be more effective in early stage 0, 1, or 2 cancers, while Hormone-Receptor-Positive breast cancer relies solely on a single pathway.
While some succeed in turning their life around, many succumb as most victors embrace fundamental changes from not engaging in romantic interactions alongside an identity crisis never experienced before. Certainly, this makes the concept of focusing on combination pathways, alongside combining other drugs as no single type has been successful; however, with enough success ranging assistance ensuring longevity of one’s life free from mental scars seems promising, as some survivors mention turning their lives around.
Types of Immunotherapy in Dealing with Breast Cancer Cells
Breast cancer is one of the notable types of cancer. Many new approaches have emerged to eradicate these cancerous cells. One such approach is referred to as immunotherapy. In simpler terms, it is a type of an approach that boosts immune system cells to help recognize and ultimately destroy affected cells. In breast cancer specifically, there are two classes of immunotherapy: active and passive. These target breast cancer in different ways.
1. Active Immunotherapy
Active immunotherapy refers to treating breast cancer by triggering the immune system to eliminate affected cells. In essence, this encourages a patient’s immune system to be able to tell the difference between healthy and cancerous cells and develop a targeted response this in turn allows the immune cells to sustain a memory of the targeted cells.
Key Examples of Active Immunotherapy:
Immune Checkpoint Inhibitors: These drugs interrupt communication so that the cancer cells can no longer camouflage and prevent immune cells from attacking them. Pricking these checkpoints renders immunity more useful in removing cancer cells. A good example would be Atezolizumab together with chemotherapy in treating specific types of triple negative breast cancers.
Cancer Vaccines: This would include anti-breast cancer vaccines that are intended to encourage the immune system to attack cancerous cells by introducing substances related to the tumor, or better known as antigens. Although vaccines against breast cancer still need to undergo more research, there is potential to lessen recurrence or treat the advanced cases.
Benefits:
- Offers memory of the immune system for a greater period of time thereby decreasing chance of recurrence.
- Targeted therapies can be provided for individual tumor types.
2. Passive Immunotherapy
Active and passive immunotherapy differ from one another in that the use of passive immunotherapy does not seek to prompt the immune system. Instead it seeks to implant synthetic elements such as antibodies, that may serve to complement what the immune system has against the disease.
Key Examples of Passive Immunotherapy:
Monoclonal Antibodies: These are genetically altered antibodies that have been created to be directed against the proteins present on breast cancer cells. For example:
Trastuzumab (Herceptin): Is a monoclonal antibody that binds to the HER2 protein which is over expressed in some breast cancer and attracts the immune response against the cancerous cells.
Pertuzumab (Perjeta): Is often used with trastuzumab in patients with HER2-positive breast cancer to enhance the trastuzumab response.
Antibody-Drug Conjugates (ADCs): These are antibodies that are linked with anti cancer drugs. Using antibodies to deliver the drug to the targeted cell so that healthy cells are unharmed. An instance is the trastuzumab emtansine (T-DM1) drug in patients with advanced breast cancer HER2 positivity.
Cytokines: Cytokines are modulating proteins composed in the immune system and can be termed immune booster proteins. Treatment methods based on cytokines in immunotherapy may improve the efficacy of the other treatments by creating tougher conditions for cancer cells.
Benefits:
- Operates as a first line of defense against cancerous cells.
- Potentiate and complements other treatments such as chemotherapy and hormone replacement therapy.
A Combination of Active and Passive Immunotherapy
To effectively address issues, several breast cancer treatment modalities combine both active and passive immunotherapies. For instance, monoclonal antibodies (passive) are sometimes administered together with checkpoint inhibitors (active) to increase efficacy against tumors.
In the course of development, additional immunotherapeutic approaches like individualized vaccines and monoclonal antibodies of the next generation are planned. These treatments aim at targeting more breast cancer subtypes such as HR-positive and triple negative breast cancer.
Breast cancer treatment has been continually improving with the development of active and passive immunotherapy approaches and offers the for better prognosis and quality of life.
Bottomline: A Decade of Excellence in Medical Oncology
Dr. Pooja Babbar’s decade-long commitment in medical oncology has been to provide advanced cancer care. Her excellence in the field of precision oncology and her performance of more than 5000 chemotherapies speaks volumes about the resolve to improve results in the treatment. She specializes in organ-based tumors; hence, she is able to explore the spheres of most recent treatment strategies from Chemotherapy, immunotherapy, and targeted therapies while treating the patients with empathy.
As always, every single patient who is struggling with cancer knows that, there is Dr. Babbar, as she always remains there to help her patients. Yes, she still uses the ‘magic wand’ which has been a mixture of knowledge plus mastery plus empathy, which not only tackles the ailments associated with cancer but also gives patients the motivation and willpower to face the difficulties. In oncology, Dr. Pooja Babbar is a name which does not require an introduction, as she has been changing lives with her work and passion for excellence. Contact us to know more!
