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Tumor Surroundings May Hold Key to TNBC Treatment Optimization

Key clinical point: Tumor microenvironment (TME) profiles could help tailor treatment for triple-negative breast cancer (TNBC).

Major finding: The immunomodulatory subtype of TNBC had a TME profile that might make it the most susceptible to immune checkpoint inhibitors.

Study details: Retrospective study of 1,512 TNBC samples from four large and publicly available transcriptomic and genomic datasets.

Disclosures: The research was supported by a grant from the Breast Cancer Research Foundation. The researchers had no conflicts of interest.


Bareche Y et al. J Natl Cancer Inst. 2019 Oct 29. doi: 10.1093/jnci/djz208.


Of particular interest in the study by Bareche et al. is the different distribution of key immune targets. The observed distinctions between the immunomodulatory and basal-like TNBC subtypes, for example, might enable more rational trial design in which immunotherapy is preferentially evaluated in the more susceptible immunomodulatory tumors rather than basal-like tumors. Their findings also suggest that TNBC tumors other than the immunomodulatory subtype might need additional approaches to make them more susceptible to immune therapy or indeed require completely different treatment approaches. Immunologic differences between TNBC subtype microenvironments are highlighted but there are also higher-level domains identified – such as in the immune response, vascularization, stromal involvement and so on – that could make the research more generally applicable in the study and refinement of novel therapeutic strategies. Their work is just one of many steps forward in looking for predictive markers of a growing number of precision treatments for breast and other cancers.

Lior Z. Braunstein, MD, and Nadeem Riaz, MD, MSc are radiation oncologists at Memorial Sloan Kettering Cancer Center, New York. Dr. Riaz is associate director of genomics operations, Immunogenomics and Precision Oncology Platform. Their comments are summarized from the editorial accompanying the study by Bareche et al.; neither had conflicts of interest.