Vloga imunskega sistema in imunoterapija pri trojno negativnem raku dojk Role of immune system in triple negative breast cancer

Abstract

Interakcija med tumorskimi celicami in imunskimi celicami v tumorski stromi je pomembna za nastanek, razvoj in progresijo raka. Pri raku dojk je najbolj preučena vloga tumorskega limfocitnega infiltrata (TIL) in izraženosti liganda za programirano smrt-1 (PD-L1). Večja izraženost TIL je neodvisni napovedni dejavnik za dosego popolne patološke remisije po neoadjuvantni sistemski terapiji pri HER2+ in trojno negativnem podtipu raka dojk in za celotno preživetje pri trojno negativnem raku dojk. Največ raziskav z zaviralci kontrolnih točk (imunoterapijo) poteka pri metastaskem trojno negativnem raku dojk. V klinični praksi se že uporablja atezolizumab v kombinaciji z nab-paklitakselom pri primarno metastatskih bolnicahh in tistih s progresom več kot 12 mesecev po adjuvantni terapiji, če imajo prekomerno izražen PD-L1. Še vedno pa se raziskuje, kateri mehanizmi in biomarkerji so udeleženi pri reakciji imunskega sistema na tumor, saj ima le majhen delež bolnikov dolgotrajno dobrobit od imunoterapije.

Abstract (Eng)

Interaction between tumor and immune cells in tumor stroma is very important for formation, developement and progression of cancer. The most evaluated are the tumor lymphocite infiltration (TIL) and the progrmmed death ligand 1 (PD-L1) expression. Higher TIL density is independent prognostic factor for achievement of complete pathologic remission (pCR) after neoadjuvant systemic treatment in HER2-positive and triple negative breast cancer. In triple negative breast cancer TIL is also prognostic for overall survival. Many studies with immunotherapy (check-point inhibitors) are ongoing in triple negative breast cancer. In the routine clinical practice patients can be treated with atezolizumab+Nab-paclitaxel in primary metastatic breast cancer and those with progression after more than 12 months after end of adjuvant treatment, if their tumors expres PD-L1. Many studies adressing mechanisms of immune system mechanisms and biomarkers are ongoing, to unreveal why only a substs of patients profits from immunotherapy.