PD-1与PD-L1抑制剂在非转移性三阴性乳腺癌新辅助治疗应用进展

Research progress of PD-1 and PD-L1 inhibitors in neoadjuvant therapy of early triple-negative breast cancer

三阴性乳腺癌(TNBC)病人肿瘤浸润性淋巴细胞(TILs)表达水平与活性明显高于其他乳腺癌亚型。多项临床试验表明,程序性死亡受体-1(PD-1)及程序性死亡受体配体-1(PD-L1)抑制剂在非转移性TNBC新辅助治疗阶段取得出色的治疗结果。此外,新辅助治疗阶段降低化疗强度联合免疫治疗或去化疗的双免疫治疗有较好的治疗前景,可能是未来发展趋势。不同于转移性TNBC,PD-L1在非转移性TNBC新辅助治疗疗效的特异度与敏感度较低,未来需结合其他免疫标记物,细化TNBC分型,有针对性地选择可从免疫治疗中获益的人群,进一步提高PD-1和(或)PD-L1抑制剂的疗效价值,从而实现TNBC的精准治疗。

The expression level and activity of tumor-infiltrating lymphocytes(TILs) in triple-negative breast cancer(TNBC) patients were significantly higher than those of other breast cancer sub-types,providing potential for immunotherapy.Multiple clinical trials have shown that PD-1 and PD-L1 inhibitors have achieved excellent therapeutic results in the neoadjuvant phase of non-metastatic TNBC.In addition,in the neoadjuvant phase,low-intensity chemotherapy combined with immunotherapy or dual immunotherapy without chemotherapy has a good therapeutic prospect and may be a future development trend.Different from metastatic TNBC,the specificity and sensitivity of PD-L1 to predict the efficacy of neoadjuvant immunotherapy in non-metastatic TNBC are relatively low.In the future,it is necessary to combine other immune markers and refine the TNBC classification,to select patients who can benefit from immunotherapy in a targeted manner,further improve the therapeutic value of PD-1 and PD-L1 inhibitors,and achieve precise treatment of TNBC.