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Immunomodulatory triple-negative breast cancers are the ones packed with immune cells. The 2016 re-analysis showed the signature comes from those lymphocytes rather than the tumour, so today the same idea is captured by counting tumour-infiltrating lymphocytes on the biopsy, which predicts a better outcome and is used to test whether some small tumours need less treatment.
The immunomodulatory (IM) subtype was enriched for immune cell processes, cytokine and antigen-processing pathways and immune signal transduction (Lehmann 2011). Laser-capture microdissection then showed those transcripts were contributed by infiltrating lymphocytes, so IM was removed as a tumour-intrinsic subtype in the four-way refinement (Lehmann 2016). Burstein's basal-like immune-activated (BLIA) subtype, defined by Stat signalling and cytokine expression, had the best disease-free and disease-specific survival of the four Burstein subtypes, and basal-like immunosuppressed (BLIS), marked by the immunosuppressing molecule VTCN1, the worst (Burstein 2015). In clinical practice the equivalent measurement is stromal tumour-infiltrating lymphocytes, and the parent page's biomarker and stage I rows carry the de-escalation cohorts; PD-L1 expression on immune cells is the treatment-selecting marker in metastatic disease (the glossary term for CPS 10 has the figures).
A research classification by gene expression (Lehmann 2011, refined 2016), not a test the NHS runs; treatment follows the triple-negative rows on the parent page.
One of the six 2011 Lehmann subtypes, traced in 2016 to infiltrating lymphocytes; its clinical counterpart, high stromal tumour-infiltrating lymphocytes, is scored on routine slides.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), Breast cancer (all types), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive breast carcinoma with medullary pattern (medullary carcinoma), Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Pembrolizumab with chemotherapy (KEYNOTE-355; NICE TA801) or with sacituzumab govitecan (ASCENT-04); the rows on the parent page.
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Query for this cancer: (TITLE:"Immunomodulatory triple-negative breast cancer" OR ABSTRACT:"Immunomodulatory triple-negative breast cancer" OR TITLE:"IM subtype" OR ABSTRACT:"IM subtype" OR TITLE:"Immunomodulatory TNBC" OR ABSTRACT:"Immunomodulatory TNBC" OR TITLE:"Basal-like immune-activated BLIA, Burstein" OR ABSTRACT:"Basal-like immune-activated BLIA, Burstein") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Immunomodulatory triple-negative breast cancer (IM), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:Pembrolizumab·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Immunomodulatory triple-negative breast cancer, then print the one-page appointment sheet with room for the answers.
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Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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