Immunotherapy for Breast Cancer Survivors: Implications for Clinical Practice

New research shows that adding immune checkpoint inhibitors (ICI) that target the PD-1/PD-L1 pathway to the standard neoadjuvant chemotherapy (NACT) for early-stage triple-negative breast cancer (TNBC) can increase the chances of a pathological complete response (pCR) and improve event-free survival (EFS), even if pCR is not achieved. It is obvious that additional therapies beyond chemotherapy are required in patients who do not acquire pCR. However, long-term immune-related toxicities are increased by adding ICI to the therapy regimen. No biomarker exists to predict which patients may benefit most from ICI. High-risk patients may benefit from ICI with NACT to improve pCR and cure rate. The four sequential steps that typically comprise immune-related adverse events (irAEs) are as follows: management includes the diagnosis and grading of irAEs, the elimination of differential diagnoses and pre-immunosuppression work-up, the selection of the best immunosuppression approach for grade 2 events, and the active evaluation at 72 h to modify treatment, respectively.