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ISBN: 978-0-323-96136-3
v
vi CONTENTS
Immune system in cancer –a friend or FOE 123 Experimental targets for TNBC under study 191
Immune system and TNBC 129 Summary 195
Immune checkpoints in TNBC 132 References 195
Newly emerging immune checkpoints 138
TIM/CEACAM1-L 139 8. Different drug delivery approaches in
TNBC metastasis and recurrence 140
combinational therapy in TNBC
Summary 140
References 141 Manzoor A. Mir, Shariqa Aisha, Umar Mehraj
Introduction 201
6. The interplay of immunotherapy, Nanocarriers as targeted drug delivery systems 202
chemotherapy, and targeted therapy in Ligands for targeted TNBC treatment 210
tripple negative breast cancer (TNBC) VLPS (virus-like particles) as unique
Manzoor A. Mir, Shazia Sofi, Hina Qayoom nanocarriers 211
Role of nanomedicine in breast cancer treatment: A
Introduction 149 transition from traditional to nanomedicine 212
An overview of immunotherapy in TNBC 150 Gene delivery 217
Immunotherapy’s potential in TNBC: Variables to be Photothermal therapy 218
considered 151 Photodynamic therapy 219
Choosing the proper immunotherapy and Nanosoldiers to suppress TNBC metastasis 219
chemotherapy combination 151 Stimulus responsive drug delivery 222
Immune checkpoint blockades in TNBC 152 Summary 223
Combination treatments involving PD1/PD-L1 160 References 224
Adoptive cell therapy 163
Cancer vaccines 165 Glossary 231
Resistance to ICI 167 Abbreviations 235
Moving immunotherapy to early TNBC 168 Index 239
Efficacy of immunotherapy and future perspectives in
TNBC 168
Summary 170
References 170
Introduction 177
An overview of targeted therapy 178
About the author
ix
Foreword
xi
Acknowledgment
The author would like to thank and Manzoor Ahmad Mir (Principal Investiga-
acknowledge the Jammu and Kashmir tor) and this book is part of the same project
Science Technology and Innovation Council entitled “Targeting Drug Resistant Cancer
(JKST&IC) for providing the financial Stem Cells by Combinational Delivery of
support vide Project No. JKST&IC/SRE/885- Paclitaxel and Quercetin Zerumbone in
87, dated 27-10-2021 sanctioned to Dr Breast Cancer.”
xvii
Preface
Breast cancer is the most widespread type specific imaging characteristics, commonly
of baleful neoplasms that develops in the showing as a mass on mammograms and
breast tissue, mostly from the ductal epithe- ultrasonography with generally benign char-
lium and is the foremost trigger of cancer- acteristics and more alarming results on
induced death among women. More than 1 magnetic resonance imaging. Epigenetics is
million new cases of breast cancer are a promising area of inquiry in modern cancer
reported per year. The heterogeneity and the research. Improvements in cancer therapy,
complexity of breast cancer make it the most detection, and prevention are feasible by
vulnerable. A report of 2018 reflects 18.1 researching the epigenetic processes driving
million cases of cancer accounting for about tumorigenesis – DNA methylation, noncod-
9.6 million deaths worldwide. Among this ing RNAs, and histone changes.
statistical count, breast cancer accounts for The worse OS, increased rate of recur-
2.1 million (11.6%) with 0.63 million (6.6%) rence, and increased occurrence of distant
deaths. Breast carcinoma is a disease with a metastases are all characteristics associated
high degree of heterogeneity. TNBC is con- with TNBC. Since TNBC is associated with
sidered to be one of the most threatening worse outcomes and thus doesn’t get benefit
types of breast cancer. Although TNBC from hormonal therapy or therapies targeted
accounts for around 15%–20% of all breast to HER2. TNBC is a very aggressive cancer,
carcinoma occurrences, it is extremely meta- and about 46% of TNBC females will develop
static, making it the most dangerous and distant metastases. TNBCs account for more
having the worst prognosis when contrasted than 80% of breast tumors in people who
to other breast carcinomas. TNBC is divided have the BRCA1 gene mutation.
into six subtypes, each with its own molecu- The treatment options for BC may include
lar profile, prognosis, and likely treatment radiotherapy, chemotherapy, immunother-
responses. Gene expression analysis shows apy, and targeted therapy. But at present,
that most TNBC possesses a basal-like chemotherapy is the only treatment that has
molecular profile. Their pathological and been approved for TNBC. Although TNBC
clinical characteristics are similar to inher- represents the most aggressive type of BC,
ited BRCA1 breast tumors. According to epi- 20% of TNBC patients show a pathologic
demiological studies, TNBC is most common complete response (pCR) after being exposed
in premenopausal younger females below 40 to neoadjuvant chemotherapy. Chemother-
years of age. Increased hip-to-waist ratios, apy is effective against TNBC, and it is still
higher parity, the shorter period of breast- the standard of care (SOC). Anthracyclines
feeding, young age at first-term pregnancy, (e.g., doxorubicin topoisomerase II inhibitor,
and shorter period of breastfeeding have all and DNA intercalating agents), alkylating
been linked to an elevated frequency of tri- compounds (e.g., cyclophosphamide), an
ple-negative breast cancers among premeno- antimicrotubule drug taxane, as well as anti-
pausal African-American women. TNBC has metabolite fluorouracil (5-FU) are all popular
xiii
xiv PREFACE
chemotherapeutics. In spite of the fact that TNBC by being used with chemotherapy for
chemotherapy is the better treatment option advanced/metastatic TNBC or chemother-
in TNBC as compared to the other forms of apy or RT as neoadjuvant/adjuvant therapy
BC, it still shows a worse prognosis. The for early TNBC and also with other targeted
main reason for this is that the disease-free drugs. With the advent of antigens that are
period between neoadjuvant and adjuvant exclusively displayed by TNBC cells and the
therapy is less and a much-threatened course advancements in monoclonal antibody tech-
in the metastatic setting. CT in combination nology, cancer vaccines, and chimeric antigen
with other treatment options may prove ben- receptors, the field of immunotherapy has
eficial for TNBC patients. At present there progressed a lot and is thus evolving as a
are various combinations of regimes that new promising approach for TNBC. The
could benefit TNBC patients, still, various field of immunotherapy has further suc-
ongoing studies are in progress to find more ceeded with the concept of intertwining the
effective regimes that may improve and lead field of chemotherapy, immunotherapy, and
to development in the treatment of TNBC. of course the targeted therapy.
Furthermore, the immune system is also With the advancements in the treatment
getting an attention for treating the disease. field of TNBC, Various biological agents have
The immune cells in this regard had played been evaluated in this aspect. In view of this,
a significant role in regulating the protumo- targeted therapy has evaluated various bio-
rigenic or anti-tumorigenic functions of the logical molecules and signaling pathways
immune system. Various immune cells in have been targeted for having effective pro-
TNBC will impact the survival outcomes in gress in the treatment of TNBC. A great focus
TNBC individuals. The expression of has been grown in the recently developed
immune-related checkpoints in TNBC targets for TNBC, for instance, the signaling
decides the survival outcomes in TNBC indi- pathways like hedgehog (Hh) pathway, notch
viduals. There are various types of immune signaling pathway, Wnt/-catenin pathway;
checkpoints that are associated with the the target molecules like (mTOR) inhibitors,
TNBC subtype. Examples include LAG3, EGFR inhibitors, PARP1 inhibitors, angiogen-
CTLA4, IDO1/2, PD-L1/2, TIGIT, and PD-1. esis inhibitors, chondroitin sulfate proteogly-
Due to the expression of such types of can 4 (CSPG4) protein targeted monoclonal
immune checkpoints, the cancer cells in antibody and TGF-inhibitors. Furthermore,
TNBC evade immunosurveillance. These various target agents are in experimental
immune checkpoints and other emerging trials for assessing their therapeutic role in
immune-related molecules could be used in treating TNBC. With the advancement of
immunotherapy and thus the progression of nanotechnologies, Nano medicine is also
the disease could be retarded in a much developing in respect of precise and speedy
better way. Immune checkpoint inhibitors diagnosis, as well as target-directed treatment
are the latest agents that show a vital role in in malignancies. Due to their target-specific
modulating the immune system of a patient multipurpose capabilities, nanoparticles are a
in such a way so that the significant destruc- crucial actor in most tumor research. Nano-
tion of the tumor cells takes place. One of the carriers have recently become the focus
most targeting pathways that are to be for improved availability, tailored cellular
blocked during immune checkpoint block- absorption, and minimum cytotoxicity. Such
ade is the PD-1/PDL-1 pathway. The immune smart nanovehicles are equipped with all of
checkpoint blockades also play their role in the required armaments (drugs, tracking
PREFACE xv
probes, and ligands) and are intended to facilitating the identification, therapy, and
target specific TNBC cells on site. Nanosol- monitoring, and so on.
diers have extraordinary ability to eliminate Summing up the contention, we see that
TNBC cells due to their variety in terms there needs to have much more evolving
of drug loading, material composition, and ways to increase the survival outcomes and
releasing process, capability to adjust in vivo to reduce the recurrence rates among TNBC
drug distribution, multifunctional properties patients.
Contributors
vii
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Language: French
ŒUVRES COMPLÈTES
DE
M. DE BALZAC
COMÉDIE HUMAINE
QUINZIÈME VOLUME
DEUXIÈME PARTIE
ÉTUDES PHILOSOPHIQUES
ÉTUDES
PHILOSOPHIQUES
PARIS,
FURNE,
J.-J. DUBOCHET ET CIE,
RUE SAINT-ANDRÉ-DES-ARTS,
RUE RICHELIEU, 60;
55;
J. HETZEL,
RUE DE MÉNARS, 10.
1845.
LE COMTE D’HÉROUVILLE
L’ENFANT MAUDIT.
ÉTUDES
P H I L OS OP H I QU E S.
MASSIMILLA DONI.
A JACQUES STRUNZ.