International Journal of Clinical Case Reports 2024, Vol.14, No.3, 167-177 http://medscipublisher.com/index.php/ijccr 170 particularly noteworthy given the aggressive nature of TNBC and its typical resistance to other forms of chemotherapy. The findings from this case highlight the potential for neoadjuvant immunotherapy to transform the treatment landscape for TNBC, improving both survival rates and quality of life for patients. Figure 2 Pathological complete response of the breast and stromal hyaline degeneration after six cycles of neoadjuvant therapy (Adopted from Zhao et al., 2023) Image caption: H&E staining at (A) ×40 magnification and (B) ×100 magnification. Arrows indicate stromal hyaline degeneration (Adopted from Zhao et al., 2023) 3.3 Case 3: regression of lymph node metastases with dendritic cell therapy In a seminal study by Kobayashi et al. (2001), the efficacy of dendritic cell (DC) therapy was evaluated in a patient with lymph node metastases from breast cancer. The patient received DCs pulsed with tumor-associated antigens, designed to activate the immune system against cancer cells. The treatment led to a significant regression of metastatic lesions in the lymph nodes, demonstrating the capacity of DC therapy to induce robust anti-tumor immune responses. This case provided early evidence supporting the feasibility and potential effectiveness of DC-based immunotherapies in treating metastatic breast cancer, paving the way for subsequent research and clinical trials in this area. These cases collectively illustrate the diverse and promising applications of immunotherapy in treating different subtypes and stages of breast cancer. They underscore the potential for these innovative treatments to achieve significant clinical benefits, even in cases where conventional therapies have failed. As research progresses, these approaches are expected to become increasingly refined and effective, offering hope for improved outcomes in breast cancer patients. 4 Challenges in Breast Cancer Immunotherapy 4.1 Tumor heterogeneity Tumor heterogeneity in breast cancer presents a significant challenge to the efficacy of immunotherapy. The genetic, histopathological, and molecular diversity within and between tumors can lead to varied responses to treatment. This heterogeneity is particularly pronounced in triple-negative breast cancer (TNBC), which exhibits high genomic instability and mutation rates, contributing to the creation of neoantigens and enhanced immunogenicity (Kúdelová et al., 2022). The complex and heterogeneous tumor immune microenvironment, characterized by disorganized gene expression and altered signaling pathways, further complicates treatment (Kúdelová et al., 2022). Additionally, the variability in immune cell infiltration and the presence of different tumor subtypes within a single patient can result in inconsistent responses to immunotherapy (Bai et al., 2020). 4.2 Immune evasion mechanisms Breast cancer tumors employ multiple mechanisms to evade immune surveillance, which significantly hampers the success of immunotherapy. These mechanisms include immunosuppression via cytokines like interleukin 10 (IL-10) and tumor growth factor beta (TGF-β), induction of tolerance through immune checkpoints such as
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