International Journal of Clinical Case Reports 2024, Vol.14, No.3, 167-177 http://medscipublisher.com/index.php/ijccr 167 Review and Progress Open Access Case-Based Analysis of Breast Cancer Immunotherapy: Efficacy, Challenges, and Future Directions Hai Huang The First Affiliated Hospital, Zhejiang University School of Medncine, Hangzhou, 310009, Zhejiang, China Corresponding email: Huanghai@qq.com International Journal of Clinical Case Reports 2024, Vol.14, No.3 doi: 10.5376/ijccr.2024.14.0018 Received: 11 May, 2024 Accepted: 14 Jun., 2024 Published: 28 Jun., 2024 Copyright © 2024 Huang, This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Huang H., 2024, Case-based analysis of breast cancer immunotherapy: efficacy, challenges, and future directions, International Journal of Clinical Case Reports, 14(3): 167-177 (doi: 10.5376/ijccr.2024.14.0018) Abstract This study evaluates the efficacy, challenges, and future directions of breast cancer immunotherapy, with a particular focus on immune checkpoint inhibitors (ICIs), CAR-T cell therapy, cancer vaccines, and monoclonal antibodies. Key findings indicate that while ICIs, especially in combination with chemotherapy, has demonstrated durable responses, its efficacy as a monotherapy remains limited, particularly in triple-negative breast cancer (TNBC). Case-based analyses reveal the potential of personalized immunotherapy approaches, such as adoptive cell transfer and neoadjuvant immunotherapy, in achieving significant clinical outcomes even in treatment-resistant cases. However, significant challenges persist, including tumor heterogeneity, immune evasion mechanisms, adverse effects, and the need for robust predictive biomarkers. The study highlights the potential of combination strategies and innovative therapies, such as bi-specific antibodies and oncolytic virus therapy, to overcome these barriers. Future research must focus on identifying precise biomarkers, understanding resistance mechanisms, and developing novel immunotherapeutic approaches to improve patient outcomes. This comprehensive analysis underscores the promising potential of immunotherapy in breast cancer treatment and the need for ongoing innovation and research to address existing challenges. Keywords Breast cancer; Immunotherapy; Immune checkpoint inhibitors (ICIs); Triple-negative breast cancer (TNBC); Predictive biomarkers 1 Introduction Breast cancer is the most commonly diagnosed cancer among women worldwide and remains a leading cause of cancer-related deaths (Basu et al., 2019; García-Aranda and Redondo, 2019; Hu et al., 2023). In 2020 alone, there were an estimated 2.3 million new cases and 685 000 deaths attributed to breast cancer globally (Luo et al., 2022). Historically, the treatment of breast cancer has relied heavily on surgery, radiation, and systemic therapies such as chemotherapy and hormone therapy. These conventional treatments have significantly improved patient outcomes, yet challenges such as tumor heterogeneity, treatment resistance, and disease recurrence persist (Basu et al., 2019; Venetis et al., 2020). The advent of immunotherapy has revolutionized cancer treatment by harnessing the body's immune system to target and destroy cancer cells. Immunotherapy has shown remarkable success in treating various cancers, including melanoma and non-small cell lung cancer (NSCLC) (Mina et al., 2019). In breast cancer, the approval of immune checkpoint inhibitors (ICIs) such as atezolizumab and pembrolizumab has marked a significant milestone, particularly for patients with triple-negative breast cancer (TNBC) (García-Aranda and Redondo, 2019; Henriques et al., 2021; Luo et al., 2022). These therapies work by blocking inhibitory pathways that prevent immune cells from attacking cancer cells, thereby enhancing the anti-tumor immune response. The introduction of immunotherapy has significantly impacted the breast cancer treatment landscape. For instance, the combination of ICIs with chemotherapy has shown promising results in improving survival rates for patients with metastatic TNBC (García-Aranda and Redondo, 2019; Luo et al., 2022; Hu et al., 2023). Additionally, other immunotherapeutic approaches such as monoclonal antibodies, adoptive cell therapy, and therapeutic vaccines are being actively explored and have shown potential in preclinical and clinical studies (Basu et al., 2019; Venetis et al., 2020; Agostinetto et al., 2022). Despite these advancements, the efficacy of immunotherapy in breast cancer is
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