三阴性乳腺癌新辅助治疗的临床研究进展

三阴性乳腺癌(triple negative breast cancer，TNBC)是一种侵袭性很强的乳腺癌，由于缺乏有效的靶向治疗，预后不佳。乳腺癌新辅助治疗由于可增加降期、保乳、保腋的概率，同时还可筛选高危人群、获得药物敏感信息指导后续用药，因此已成为TNBC的重要治疗策略。本文综述了TNBC新辅助治疗的最新进展，包括铂类、免疫抑制剂、多腺苷二磷酸核糖聚合酶［poly(adenosine diphosphate-ribose)polymerase，PARP］抑制剂、磷脂酰肌醇-4,5-二磷酸3激酶催化亚基(PIK3CA)途径靶向治疗、肿瘤微环境(TME)靶向治疗。     

Regulatory T cells and breast cancer: implications for immunopathogenesis

Current understanding of the role of several cancer risk factors is more comprehensive, as reported for a number of sites, including the brain, colon, breasts, and ovaries. Despite such advances, the incidence of breast cancer continues to increase worldwide. Signals from the microenviroment have a profound influence on the maintenance or progression cancers. Although T cells present the most important immunological response in tumor growth in the early stages of cancer, they become suppressive CD4⁺ and CD8⁺ regulatory T cells (Tregs) after chronic stimulation and interactions with tumor cells, thus promoting rather than inhibiting cancer development and progression. Tregs have an important marker protein which is FoxP3, though it does not necessarily confer a Treg phenotype when expressed in CD4⁺ T lymphocytes. High Treg levels have been reported in peripheral blood, lymph nodes, and tumor specimens from patients with different types of cancer. The precise mechanisms by which Tregs suppress immune cell functions remain unclear, and there are reports of both direct inhibition through cell–cell contact and indirect inhibition through the secretion of anti-inflammatory mediators such as interleukin. In this review, we present the molecular and immunological aspects of Treg cells in the metastasis of breast cancer.     

The functional and prognostic implications of regulatory T cells in colorectal carcinoma

One of the cornerstones for the immune system is the discovery of T-regulatory cells (Treg), which play an essential role in maintaining self regulation of the immune response to foreign threats. However, they may also interfere with the immune response to tumoral cells, for which reason much effort has been put into characterizing the molecular makeup of this T cell population. It has been shown that Tregs are increased in the peripheral blood of patients with many cancer types, and also enriched in the tumor sites. However, the significance of this phenomenon on prognosis is controversial, especially in colorectal carcinoma, one of the most common cancers worldwide and a major cause of cancer-related death. This literature review focuses on characterization of the Treg cells in colorectal cancer patients and its implications on the prognosis of this disease. In the end, the potential therapeutic strategies aimed at Treg modification are discussed.     

肿瘤-睾丸抗原在乳腺癌中的研究现状

The cancer-testis antigens (CTA) are an expanding family of tumor-associated antigens includingMAGE and NY-ESO-1, which have specifi c expression patterns. Because of their ability to elicit autologouscellular immune responses in tumor patients, CTAs have been identified important candidates for cancerimmunotherapy. This article reviews the expression of CTAs in breast cancer, especially the expressionin the triple negative breast cancer (TNBC) and their clinical signifi cance. This provides the new conceptand thinking for immunization strategies in breast cancer. CTA appears an ideal target for TNBC specificimmunotherapy.     

阿特珠单抗治疗三阴性乳腺癌的研究进展

三阴性乳腺癌(triple-negative breast cancer,TNBC)预后差,治疗方法选择有限。然而,已知TNBC与其他乳腺癌亚型相比具有更强的免疫原性,其中肿瘤浸润淋巴细胞(tumor-infiltrating lymphocytes,TILs)起着重要的预后和预测作用。此外,TNBC具有较高水平的程序性死亡配体1(PD-L1)表达。因此,使用阿特珠单抗阻断PD-L1治疗有望激活并增强肿瘤特异性 T 细胞应答,从而改善抗肿瘤活性。阿特珠单抗是一种靶向PD-L1的新型免疫检查点抑制剂（immune checkpoint inhibitors,ICPi）,更是转移性TNBC的一种有效且耐受性良好的治疗选择,还有可能大幅增加TNBC的治疗效果。这将改善免疫治疗策略,提高乳腺癌患者的结局。     

调节性T细胞在结直肠癌发生发展中的作用及相关治疗

调节性T细胞（regulatory T cell,Treg）是肿瘤微环境中重要的免疫抑制性细胞,在维持免疫稳态方面发挥重要的作用。Treg不仅可以通过分泌抑制性细胞因子阻碍有效的抗肿瘤免疫,还可以通过调节细胞因子进而调控结直肠癌（colorectal cancer,CRC）细胞生长,同时直接或间接地促进CRC血管新生,并与患者不良预后有关;但Treg也可能在炎症相关性肿瘤发生的早期,通过抑制炎症反应降低肠道肿瘤发生的风险。近年来,靶向Treg的免疫治疗也成为了研究热点,一些治疗策略已经在临床应用,还有一些正在进行临床前及临床试验。本文就Treg在CRC发生发展中的作用及靶向Treg的免疫治疗策略进行综述,探讨Treg作为治疗靶点的作用机制及临床应用前景。      

Microbiome Assisted Tumor Microenvironment: Emerging Target of Breast Cancer

The microbiome assisted tumor microenvironment (TME) supports the tumors by modulating multiple mechanisms. Recent studies reported that microbiome dysbiosis is the main culprit of immune suppressive phenotypes of TME. Further, it has been documented that immune suppressive stimulate metastatic phenotype in TME via modulating signaling pathways, cell differentiation, and innate immune response. This review aims at providing comprehensive developments in microbiome and breast TME interface. The combination of microbiome and breast cancer, breast TME and microbiome or microbial dysbiosis, microbiome and risk of breast cancer, microbiome and phytochemicals or anticancer drugs were as used keywords to retrieve literature from PubMed, Google scholar, Scopus, Web of Science from 2015 onwards. Based on the literature, we presented the impact of TME assisted microbiome dysbiosis and estrobolome in breast cancer risk, drug resistance, and antitumor immunity. We have discussed the influence of antibiotics on the breast microbiome. we also presented the possible dietary phytochemicals that target microbiome dysbiosis to restore the tumor suppression immune environment in breast TME. We presented the microbiome as a possible marker for breast cancer diagnosis. This study will help in the identification of microbiome as a novel target and diagnostic markers and phytochemicals and microbiome metabolites for breast cancer treatment.     

T-independent response mediated by oncolytic tanapoxvirus recombinants expressing interleukin-2 and monocyte chemoattractant protein-1 suppresses human triple negative breast tumors

Human triple negative breast cancer (TNBC) is an aggressive disease, associated with a high rate of recurrence and metastasis. Current therapeutics for TNBC are limited, highly toxic and show inconsistent efficacy due to a high degree of intra-tumoral and inter-tumoral heterogeneity. Oncolytic viruses (OVs) are an emerging treatment option for cancers. Several OVs are currently under investigation in preclinical and clinical settings. Here, we examine the oncolytic potential of two tanapoxvirus (TPV) recombinants expressing mouse monocyte chemoattractant protein (mMCP)-1 [also known as mCCL2] and mouse interleukin (mIL)-2, in human TNBC, in vitro and in vivo. Both wild-type (wt) TPV and TPV recombinants demonstrated efficient replicability in human TNBC cells and killed cancer cell efficiently in a dose-dependent manner in vitro. TPV/?66R/mCCL2 and TPV/?66R/mIL-2 expressing mCCL2 and mIL-2, respectively, suppressed the growth of MDA-MB-231 tumor xenografts in nude mice significantly, as compared to the mock-injected tumors. Histological analysis of tumors showed areas of viable tumor cells, necrotic foci and immune cell accumulation in virus-treated tumors. Moreover, TPV/?66R/mIL-2-treated tumors showed a deep infiltration of mononuclear immune cells into the tumor capsule and focal cell death in tumors. In conclusion, TPV recombinants expressing mCCL2 and mIL-2 showed a significant therapeutic effect in MDA-MB-231 tumor xenografts, in nude mice through induction of potent antitumor immune responses. Considering the oncolytic potency of armed oncolytic TPV recombinants expressing mCCL2 and mIL-2 in an experimental nude mouse model, these viruses merit further investigation as alternative treatment options for human breast cancer.     

Checkpoint inhibitors in triple‐negative breast cancer (TNBC): Where to go from here

Advances in cancer immunotherapy and a growing body of research have focused on the role of the antitumor response in breast cancer. Triple‐negative breast cancer (TNBC) is the most immunogenic breast cancer subtype, and there is strong evidence that tumor‐infiltrating lymphocytes in TNBC have prognostic value and are associated with clinical outcome and improved survival. Evading antitumor immunity is a hallmark for the development and progression of cancer. Immunotherapy studies have focused on the role of the programmed cell death‐1 (PD‐1) receptor/programmed death‐ligand 1 (PD‐L1) pathway in maintaining immunosuppression in the tumor microenvironment. Blockade of the PD‐1/PD‐L1 axis has emerged as a promising therapeutic option to enhance antitumor immunity and is actively being investigated in TNBC, with encouraging results. In this article, the authors review the current literature on checkpoint inhibitors in TNBC with a focus on PD‐1/PD‐L1 antibodies and discuss combination strategies and novel approaches for improving antitumor immunity and clinical outcome. Cancer 2018;124:2086‐103 . © 2018 American Cancer Society.     

溶血磷脂信号在上皮性卵巢癌微环境中作用的研究进展

卵巢癌是妇科恶性肿瘤死亡的主要原因,发生在肿瘤微环境(TME)中的包括脂质代谢改变在内的代谢重编程是其主要特征。脂质中的几种溶血磷脂（也称癌脂）如溶血磷脂酸（LPA)是TME的重要组成部分,参与了肿瘤发生、发展的各个方面。本文综述了上皮性卵巢癌（EOC）TME中脂质代谢的改变,包括脂肪酸氧化增强、其它几种脂肪酸含量的改变,其次是溶血磷脂信号在EOC中的研究进展,重点介绍了LPA在EOC的TME中的作用:促进卵巢癌细胞的增殖、削弱免疫监测、侵袭转移、对化疗药物的抵抗等。     

PD-1/PD-L1抑制剂与多药联合治疗三阴性乳腺癌的研究进展

因缺乏明确的分子靶点,三阴性乳腺癌（TNBC）与其他乳腺癌亚型相比是较难治疗以及预后较差的乳腺癌亚型。程序性死亡受体-配体1（PD-L1）在TNBC中表达明显增加,其免疫逃逸机制使其更适用于免疫检查点阻断治疗。然而,临床试验中TNBC对抗PD-L1或抗程序性死亡受体1（PD-1）治疗的反应率并不令人满意,客观反应率只有10%~20％,可能与TNBC具有免疫沉默效应有关,因此免疫检查点阻断剂与其他药物的联合策略可能会增加TNBC的临床获益率。本文综述TNBC中PD-1/PD-L1抑制剂联合其他药物的研究进展,为临床医生设计多药联合策略提供依据。     

CD8⁺ cytotoxic T cell and FOXP3⁺ regulatory T cell infiltration in relation to breast cancer survival and molecular subtypes

The prognostic significance of tumor-associated FOXP3⁺ regulatory T cells (Tregs) and CD8⁺ cytotoxic T lymphocytes (CTLs) in invasive breast carcinomas is studied. Tregs and CTLs were assessed by immunohistochemistry in 1270 cases of invasive breast carcinoma for their associations with patient survival, histopathologic features, and molecular subtypes. Infiltrates of Tregs and CTLs were observed within tumor bed and in the tissue surrounding tumor. Within tumor bed, increased infiltration of Tregs and CTLs was significantly more common in those with unfavorable histologic features, including high histologic grade and negative ER and PR status. In addition, high density Treg infiltration was also associated with tumor HER2 overexpression, decreased overall survival (OS) and progression-free survival (PFS). In tissue surrounding tumor, in contrast, high CTL/Treg ratio was found to be significantly associated with improved OS and PFS. These prognostic associations were confirmed by multivariate analysis. Furthermore, the density of Treg infiltrates within tumors was inversely correlated with the prognosis of the molecular subtypes of tumors. The ratio of CTL/Treg infiltrates in the surrounding tissue was also significantly higher in luminal than non-luminal subtypes of carcinoma. The prognostic significances of Tregs and CTLs in breast carcinoma depend on their relative density and location. The density of intratumoral Treg infiltrates and the peritumoral CTL/Treg ratio are independent prognostic factors and correlated with the prognosis of the molecular subtypes of breast carcinoma, which may serve as potential target for stratifying immunotherapy to battle against the aggressive subtypes of breast carcinoma.     

Regulatory T (Treg) cells in cancer: Can Treg cells be a new therapeutic target?

Regulatory T (Treg) cells suppress abnormal/excessive immune responses to self‐ and nonself‐antigens to maintain immune homeostasis. In tumor immunity, Treg cells are involved in tumor development and progression by inhibiting antitumor immunity. There are several Treg cell immune suppressive mechanisms: inhibition of costimulatory signals by CD80 and CD86 expressed by dendritic cells through cytotoxic T‐lymphocyte antigen‐4, interleukin (IL)‐2 consumption by high‐affinity IL‐2 receptors with high CD25 (IL‐2 receptor α‐chain) expression, secretion of inhibitory cytokines, metabolic modulation of tryptophan and adenosine, and direct killing of effector T cells. Infiltration of Treg cells into the tumor microenvironment (TME) occurs in multiple murine and human tumors. Regulatory T cells are chemoattracted to the TME by chemokine gradients such as CCR4‐CCL17/22, CCR8‐CCL1, CCR10‐CCL28, and CXCR3‐CCL9/10/11. Regulatory T cells are then activated and inhibit antitumor immune responses. A high infiltration by Treg cells is associated with poor survival in various types of cancer. Therefore, strategies to deplete Treg cells and control of Treg cell functions to increase antitumor immune responses are urgently required in the cancer immunotherapy field. Various molecules that are highly expressed by Treg cells, such as immune checkpoint molecules, chemokine receptors, and metabolites, have been targeted by Abs or small molecules, but additional strategies are needed to fine‐tune and optimize for augmenting antitumor effects restricted in the TME while avoiding systemic autoimmunity. Here, we provide a brief synopsis of these cells in cancer and how they can be controlled to achieve therapeutic outcomes.     

Increased Frequency of Foxp3+ Regulatory T Cells in Mice with Hepatocellular Carcinoma

The CD4+CD25+ regulatory T cell (Treg) is a special kind of T cell subset. Studies have showed that Tregcells are involved in a number of physiological processes and pathologic conditions such as autoimmune diseases,transplantation tolerance and cancer. Tregs with unique capacity for immune inhibition can impair anti-tumourimmunity and help tumor cells to escape from immune surveillance. The aim of our study was to investigatewhether Tregs are involved in hepatocellular carcinoma (HCC). A BABL/C mouse with HCC in situ model wasestablished to evaluate the Treg existence in carcinoma tissues and the changes of Tregs in spleen using flowcytometry and immunohistochemistry methods. Granzyme B expression in carcinoma tissues was analyzedby immunohistochemistry to investigate the tumor local immune status.The proportion of CD4+CD25+/CD4+spleen lymphocytes of tumor bearing mice (18.8%±1.26%) was found to be significantly higher than that innormal mice (9.99%±1.90%) (P<0.01 ). Immunohistochemistry of spleen tissue also confirmed that there wasan increase in Treg in tumor-bearing mice, while in carcinomas it showed Treg cells to be present in tumorinfiltrating lymphocyte areas while Granzyme B was rarely observed. Anti-tumour immunity was suppressed,and this might be associated with the increase of Tregs. Our observations suggest that the CD4+CD25+Treg/CD4+ proportion in spleen lymphocytes can be a sensitive index to evaluate the change of Tregs in hepatocellularcarcinoma mice and the Treg may be a promising therapeutic target for cancer.     

Peritumoral FOXP3+ regulatory T cell is sensitive to chemotherapy while intratumoral FOXP3+ regulatory T cell is prognostic predictor of breast cancer patients

It has been reported that the prognostic significances of tumor-infiltrating FOXP3(+) regulatory T cells (Tregs) in breast carcinoma depend on their relative density and tissue locations. We here assessed the changes of Tregs before and after neoadjuvant chemotherapy (NC) and their relationships with tumor response and patient survival. Intratumoral and peritumoral infiltration of FOXP3(+) Tregs were evaluated by immunohistochemistry in 132 cases of invasive breast carcinomas before and after NC. After NC, the density of infiltrated Tregs within tumor bed remained stable, whereas it decreased significantly (P?=?0.015) in the tissue surrounding tumor. The changes were significant in those tumors that usually response to NC, including the HER2-enriched and basal-like subtypes (P?=?0.035; P?=?0.004). Univariate and multivariate analyses identified the decreased peritumoral Tregs were an independent predictor for pathologic complete response (pCR), while the intratumoral Tregs after chemotherapy was proved to be associated with overall survival and progression-free survival of the patients. The findings of the study indicated that peritumoral Treg was sensitive to chemotherapy and associated with pCR, while intratumoral Treg was an independent prognostic predictor of breast cancer patients.     

三阴性乳腺癌雄激素受体研究进展

三阴性乳腺癌(triple-negative breast cancer,TNBC)是一组异质性疾病,缺乏有效的靶向治疗,预后差。近年来研究证实,雄激素受体(androgen receptor,AR)在TNBC的发生、发展中起重要作用。AR成为TNBC中研究的热点,并可能成为TNBC靶向治疗的新选择。该研究将对三阴乳腺癌与AR表达进行相关阐述,并提供在TNBC中靶向AR信号通路的新视野。     

Sorafenib relieves cell‐intrinsic and cell‐extrinsic inhibitions of effector T cells in tumor microenvironment to augment antitumor immunity

Sorafenib, a multitargeted antiangiogenic tyrosine kinase inhibitor, is the standard of care for patients with advanced hepatocellular carcinoma (HCC). Cumulating evidence suggests that sorafenib differentially affects immune cells; however, whether this immunomodulatory effect has any impact on antitumor immune responses is unknown. Using an orthotopic mouse model of HCC and tumor‐free mice, we investigated the effects of sorafenib on antitumor immunity and characterized the underlying mechanisms. Sorafenib treatment inhibited tumor growth and augmented antitumor immune responses in mice bearing established orthotopic HCC. The tumor‐specific effector T cell functions were upregulated, while the proportion of PD‐1‐expressing CD8⁺ T cells and regulatory T cells (Tregs) was reduced in tumor microenvironment of sorafenib‐treated mice. Mechanistically, the sorafenib‐mediated effects on Tregs could be independent of its direct tumor‐suppressing activities. Sorafenib treatment reduced Treg numbers by inhibiting their proliferation and inducing apoptosis. Moreover, sorafenib inhibited the function of Tregs, characterized by diminished expression of Treg‐associated molecules important for their function and by their impaired suppressive capacity. These data reveal that sorafenib treatment enhanced functions of tumor‐specific effector T cells as well as relieved PD‐1‐mediated intrinsic and Treg‐mediated non‐cell‐autonomous inhibitions in tumor microenvironment leading to effective antitumor immune responses. In addition to the well‐known tumor‐inhibiting activity of sorafenib, its enhancement of antitumor immunity may also contribute to the clinical efficacy. Our findings uncover a previously unrecognized mechanism of action of sorafenib and indicate that sorafenib represents a potential targeted agent suitable to be combined with immunotherapeutic approaches to treat cancer patients.     

调节性T细胞诱导肿瘤免疫耐受的机制

调节性T细胞(Treg)是一类免疫抑制性T辅助(Th)细胞.研究表明,Treg可在肿瘤细胞分泌的趋化因子CCL22作用下大量募集于肿瘤周围,分泌或表达免疫抑制性的细胞因子和受体,形成以Th2型免疫为主的微环境,引导宿主免疫耐受.通过抗体等药物降低Treg数量和活性后可打破肿瘤免疫耐受,抑制肿瘤的发生和转移.