The landscape of cancer treatment is undergoing some major changes as more clinicians are looking to not just utilize one specific treatment method for each patient but are looking to combine different methods that will trigger favorable responses in some patients.

At the European Society of Medical Oncology 2019 Congress Rebecca Dent, MD, medical oncologist at the National Cancer Centre in Singapore, spoke with 

 on the future of combination therapies, specifically utilizing immunotherapy to treat patients with early-stage breast cancer.    

For the longest time, we think of chemotherapy has just been chemotherapy, as a cytotoxic and I think different chemotherapies likely have some immunomodulatory effects. So, there was the TONIC trial also that showed us that chemotherapy can act as a primer. In addition, radiation actually, potentially can help us create new antigens that can present to the immune system. So, we’ve seen some really interesting data from our colleagues in lung and melanoma looking at combining radiation and checkpoint inhibition.

Now there are numerous other combinations that are being developed and I think that's where we have to really look down and sort of say, look at the immune profiling that we can now do, and you can see that there are certain ones that are inflamed, but they're also that, say, certain groups of patients that actually have an immune cold tumor that you need to figure out how do we activate those T cells? And so, these different combinations, I think, in the future are going to be what's most exciting. Can we convert a PD-L1 negative to a PD-L1 positive tumor? There are also many different combinations that are being explored, right now mostly in the metastatic setting, but I think that's the way of the future.

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Experts are looking to use immunotherapy in different ways for patients with early-stage breast cancer. 

Rebecca Dent, MD

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Expert Weighs in on Treating Early-Stage Breast Cancer With Immunotherapy