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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Monday, November 28, 2022
According to Federica Miglietta, MD, of the University of Padova, Italy, “the story of the immune system and breast cancer may be more complex than we suspected.” Based on the results of a study conducted by Dr. Miglietta and colleagues, it appears that in patients with HER2-positive breast cancer who had tumor-infiltrating lymphocytes (TIL) on more than 15% of the surface area of their tumors and received neoadjuvant therapy, overall survival was significantly shorter than in those with lower TIL levels. In fact, 68% of patients with high TIL levels in their residual disease were alive after 5 years, compared with 84% of those with low TIL levels. The researchers used this information to develop a prognostic model for predicting the probability of overall survival in this patient population. These study results were presented during the closing plenary session at the 2022 European Breast Cancer Conference (EBCC; presentation number PPT-147).
“The fact that higher levels of TILs in residual disease are associated with worse outcomes seems to be a distinct feature of HER2-positive cancer. Indeed, the opposite has been consistently reported for triple-negative breast cancer,” commented Dr. Miglietta in an EBCC press release. “This suggests that the behavior of the residual disease immune microenvironment is highly dynamic and is strictly related to breast cancer type and exposure to treatment.”
The study included 292 patients with HER2-positive breast cancer who received neoadjuvant therapy. More than two-thirds of patients (n = 195) had residual disease after neoadjuvant therapy. Residual cancer burden scores were calculated and found to be significantly associated with overall survival. In addition, as mentioned, high residual disease TILs were significantly associated with poorer overall survival, with 5-year overall survival rates for those with high versus low residual disease TILs of 67.9% versus 83.7% (P = .028). According to the investigators, the residual cancer burden plus TIL score provided additional prognostic information than either one alone.
Disclosure: The study authors reported no conflicts of interest.
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