Immuntherapie bei Brustkrebs

Während bei anderen soliden Tumoren Immuntherapie seit Jahren zum Therapiestandard gehört, steht sie bei Brustkrebs noch ganz am Anfang. Klinisch relevant ist sie beim triple-negativen Mammakarzinom (TNBC). Seit 2019 ist der PD-L1-Inhibitor (PD-L1: Programmed death-ligand 1) hemmen. Atezolizumab ist als Erstlinientherapie beim metastasierten TNBC zugelassen. Vielversprechende Daten gibt es auch zur neoadjuvanten Therapie bei TNBC sowohl für Atezolizumab als auch für den PD1 Inhibitor Pembrolizumab. Studien beim luminalen frühen Mammakarzinom laufen aktuell.

• Literatur

• 1 Marra A, Trapani D, Viale G. et al. Practical classification of triple-negative breast cancer: intratumoral heterogeneity, mechanisms of drug resistance, and novel therapies. NPJ Breast Cancer 2020; 6: 54
• 2 Schmid P, Adams S, Rugo HS. et al. IMpassion130 Trial Investigators. Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med 2018; 379: 2108-2121
• 3 Schmid P, Rugo HS, Adams S. et al. IMpassion130 Investigators. Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable, locally advanced or metastatic triple-negative breast cancer (IMpassion130): updated efficacy results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21: 44-59
• 4 Rugo HS, Loi S, Adams S. et al. Performance of PD-L1 immunohistochemistry (IHC) assays in unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC): Post-hoc analysis of IMpassion130. Ann Oncol 2019; 30 (Suppl. 05) v851-v934
• 5 Miles DW, Gligorov J, André F. et al. Primary results from IMpassion131, a double-blind placebo-controlled randomised phase III trial of first-line paclitaxel (PAC) ± atezolizumab (atezo) for unresectable locally advanced/metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2020; 31 (Suppl. 04) S1142-S1215
• 6 Cortes J, Cescon DW, Rugo HS. et al. KEYNOTE-355 Investigators. Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial. Lancet 2020; 396: 1817-1828
• 7 Cortés J, Lipatov O, Im S. et al. KEYNOTE-119: Phase 3 study of pembrolizumab (pembro) versus single-agent chemotherapy (chemo) for metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2019; 30 (Suppl. 05) v851-v934 doi:10.1093/annonc/mdz394
• 8 Schmid P, Cortes J, Pusztai L. et al. KEYNOTE-522 Investigators. Pembrolizumab for Early Triple Negative Breast Cancer. N Engl J Med 2020; 382: 810-821
• 9 Mittendorf EA, Zhang H, Barrios CH. et al. Neoadjuvant atezolizumab in combination with sequential nab-paclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early-stage triple-negative breast cancer (IMpassion031): a randomised, double-blind, phase 3 trial. Lancet 2020; 396: 1090-1100
• 10 Gianni L, Huang C, Egle D. et al. Pathologic complete response to neoadjuvant treatment with or without atezolizumab in triple-negative, early high-risk and locally advanced breast cancer. NeoTRIPaPDL1 Michelangelo randomized study. San Antonio Breast Cancer Symposium 2019; Abstr. GS3-04.
• 11 Bianchini G, Huang C, Egle D. et al. Tumour infiltrating lymphocytes (TILs), PD-L1 expression and their dynamics in the NeoTRIPaPDL1 trial. Ann Oncol 2020; 31 (Suppl. 04) S1142-S1215
• 12 Gluz O, Nitz U, Liedtke C. et al. Comparison of Neoadjuvant Nab-Paclitaxel+Carboplatin vs. Nab-Paclitaxel+Gemcitabine in Triple-Negative Breast Cancer: Randomized WSG-ADAPT-TN Trial Results. J Natl Cancer Inst 2018; 110: 628-637
• 13 AGO Kommission Mamma. Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome. Version 2020.1. Online (Stand: 01.12.2020): http://www.ago-online.de