Cancer immunotherapy through the ages: Historical development, current role and future perspectives in triple-negative breast cancer

Cancer immunotherapy has progressed from early hypotheses of immune surveillance to established checkpoint-inhibitor regimens in selected cancers.This article connects major historical discoveries with the current evidence for immunotherapy in triple-negative breast cancer (TNBC), while distinguishing findings from early-stage and metastatic disease.In metastatic TNBC, chemotherapy plus pembrolizumab improved overall survival among patients with programmed death ligand 1 combined positive score of at least 10 in KEYNOTE-355.In high-risk early-stage TNBC, perioperative pembrolizumab improved 5-year overall survival in KEYNOTE-522.Contrasting results between the IMpassion130 and IMpassion131 trials illustrate the importance of treatment context and assay interpretation.Recent antibody-drug conjugate combinations, circulating tumour DNA and fragmentomic biomarkers offer further possibilities, although several remain investigational.Resistance, immune-related toxicity, cost, heterogeneous programmed death ligand 1 testing and uncertainties about treatment sequencing remain important challenges.Contemporary evidence supports more precise patient selection and carefully designed trials, not universal benefit from checkpoint inhibition.