Abstract
Simple SummaryDespite recent advances in the treatment of other breast cancer subtypes, inflammatory breast cancer (IBC) remains a significant clinical challenge, with an overall 5-year survival rate of 39%. Though immunotherapy has shown remarkable efficacy in other difficult-to-treat cancers, such approaches have yet to show substantial therapeutic efficacy in IBC. Here, we summarize the known immune composition of IBC tumors, as well as past and present efforts to advance immunotherapy in the treatment of IBC.Inflammatory breast cancer (IBC) is a rare and aggressive subtype of breast cancer that carries a particularly poor prognosis. Despite the efficacy of immunotherapy in other difficult to treat forms of breast cancer, progress for immunotherapy in IBC has been difficult. Though immunotherapy has been under clinical investigation in IBC since the 1970s, few approaches have shown significant therapeutic efficacy, and no immunotherapy regimens are currently used in the treatment of IBC. Here, we provide a comprehensive summary of what is known about the immune composition of IBC tumors, clinical and basic science evidence describing the role for immune checkpoints such as PD-L1 in IBC pathobiology, as well as past and present attempts to advance ICIs in the treatment of IBC.
Highlights
While clinical outcomes are improving for most breast cancer subtypes, inflammatory breast cancer (IBC) still carries a poor prognosis with an overall 5-year survival rate of 39% [1]
While they found no significant difference in tumor-infiltrating lymphocytes (TILs) infiltration between Inflammatory breast cancer (IBC) and non-IBC tumors in the luminal and triple-negative subgroups, Human epidermal growth factor receptor 2 (HER2)-enriched IBC tumors had increased TILs compared to HER2-enriched, non-IBC tumors [33]
Though the role for plasmacytoid dendritic cells (pDCs) is less established in IBC compared to other breast cancer subtypes, select studies suggest these findings may be applicable to IBC
Summary
While clinical outcomes are improving for most breast cancer subtypes, inflammatory breast cancer (IBC) still carries a poor prognosis with an overall 5-year survival rate of 39% [1]. Results were shared from a European phase II trial of bevacizumab with paclitaxel, carboplatin, and cyclophosphamide with or without trastuzumab and endocrine therapy in the neoadjuvant setting This approach was associated with a high rate of pathologic complete responses, for HER2-positive IBC, as well as improved overall and disease-free survival [13]. The BEVERLY-2 trial (NCT00717405) evaluated this approach in 52 patients with HER2-positive IBC These results appear to suggest that the addition of bevacizumab is efficacious and well tolerated in patients [15], though further study is required prior to advancing bevacizumab in the treatment of IBC [16]. These and other cell types warrant further study in the complex and dynamic IBC TME, in the setting of cancer immunotherapy
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