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Immunotherapy is the use of medicines to boost a person’s own immune system to recognize and destroy cancer cells more effectively. Immunotherapy can be used to treat some types of breast cancer.

Immune checkpoint inhibitors for breast cancer in men

The immune system uses checkpoint proteins on immune cells to tell the difference between normal cells and those it sees as foreign, such as germs and cancer cells. These checkpoints act like switches that turn immune responses on or off, helping the body avoid attacking its own tissues.

Breast cancer cells can sometimes use these checkpoints to avoid being attacked by the immune system.

Checkpoint inhibitors are drugs that target checkpoint proteins, which can sometimes help the immune system see and attack breast cancer cells.

PD-1 inhibitors for breast cancer in men

Pembrolizumab (Keytruda) and dostarlimab (Jemperli) target PD-1, a checkpoint protein on immune system cells called T cells that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against breast cancer cells.

Pembrolizumab

Pembrolizumab can be used with chemotherapy to treat triple-negative breast cancer:

• Before and after surgery, if the cancer is at high risk for coming back
• That has come back (recurred) locally but can’t be removed by surgery*

• That has spread to other parts of the body*

*In these situations, your doctor will likely test your cancer cells for the PD-L1 protein before treatment to check whether the cancer is likely to respond to pembrolizumab.

Pembrolizumab might also be an option by itself to treat advanced breast cancer if the cancer cells test positive for specific gene changes, such as:

• A high level of microsatellite instability (MSI-H)
• Defects in one of the mismatch repair genes (dMMR)
• A high tumor mutational burden (TMB-H)

This drug is given as an infusion into a vein (IV), typically every 3 or 6 weeks.

Dostarlimab

Dostarlimab can be used by itself to treat advanced breast cancer if the cancer cells test positive for defects in one of the mismatch repair genes (dMMR).

This drug is given as an infusion into a vein (IV), typically every 3 or 6 weeks.

Possible side effects of immune checkpoint inhibitors

Side effects of these drugs can include:

• Fatigue
• Cough
• Nausea
• Skin rash
• Poor appetite
• Constipation or diarrhea

Other, more serious side effects occur less often.

Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.

Autoimmune reactions: These drugs remove one of the safeguards on the body's immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.

It’s very important to report any new side effects to your health care team quickly. If serious side effects do occur, treatment may need to be stopped, and you may get high doses of corticosteroids to suppress your immune system.