In hormone receptor-positive (HR+) breast cancer, the tumor immune microenvironment (TIM) is uniquely shaped by estrogen signaling, which not only suppresses immune activity but also fosters a microenvironment conducive to late recurrence. This makes late recurrence a critical issue that must not be underestimated in these patients.
Estrogen promotes immunosuppressive mechanisms, such as polarizing macrophages toward the M2 subtype and enhancing Tregs and myeloid-derived suppressor cells (MDSCs). Conversely, CDK4/6 inhibitors and endocrine therapies offer a dual benefit: they block estrogen signaling while also reshaping the TIM. CDK4/6 inhibitors, in particular, have shown promise in triggering anti-tumor immunity and reducing recurrence risk. Excitingly, ongoing research is exploring how different CDK4/6 inhibitors uniquely modulate the TIM, potentially paving the way for more precise and effective treatment strategies in HR+ breast cancer.
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