IMMUNOTHERAPY combined with standard neoadjuvant chemotherapy has shown encouraging benefits in hormone receptor positive, HER2 negative early breast cancer, according to new evidence. Recent clinical data indicate that immune checkpoint inhibitors (ICIs) significantly raise pathological complete response (pCR) rates in this patient group, though immune-related adverse effects remain a concern. The findings highlight both the promise and complexity of integrating immunotherapy into treatment pathways for early disease.
While immunotherapy has become a mainstay in triple negative breast cancer, its use in hormone receptor positive tumors has been more challenging due to their comparatively lower immunogenicity. Trials adding ICIs to chemotherapy have reported measurable improvements in tumor eradication before surgery, but the clinical significance of these higher pCR rates requires confirmation with long-term survival outcomes. Importantly, the gains in response are balanced against increased immune-mediated toxicities, necessitating careful patient selection and monitoring.
Innovative strategies are under investigation to enhance the effectiveness of ICIs in this setting. Radiation therapy delivered alongside immunotherapy is one such approach, with early data suggesting that it may amplify antitumor immune activity. These combinations could help overcome resistance mechanisms that have traditionally limited immunotherapy efficacy in luminal-like breast cancers.
Experts stress the need for validated predictive biomarkers to identify patients most likely to benefit from immunotherapy while avoiding unnecessary toxicity in others. As novel combinations and treatment schedules are refined, precision approaches will be key to optimizing outcomes. For now, immunotherapy in the neoadjuvant setting represents a rapidly evolving frontier with the potential to shift standard care for hormone receptor positive, HER2 negative early breast cancer, pending confirmation from ongoing trials with longer follow-up.
Reference:
Arecco L et al. Immunotherapy in the neoadjuvant treatment of hormone receptor positive/HER2 negative early breast cancer: novel approaches and future perspectives. Curr Opin Oncol. 2025. doi:10.1097/CCO.0000000000001183
