The neuroimmune axis in breast cancer: from mechanistic insights to clinical applications

BACKGROUND: Breast cancer is the most commonly diagnosed malignancy in women worldwide, and its marked heterogeneity together with the complexity of the tumor microenvironment contributes to substantial variability in therapeutic responses. Although conventional studies have mainly focused on tumor cell-intrinsic alterations, increasing evidence has identified the neuroimmune axis as a critical regulator of breast cancer progression and treatment resistance. MAIN BODY: The neuroimmune axis involves bidirectional crosstalk between the nervous system and the immune system, mediated by neurotransmitters, neuropeptides, and neurotrophins. These mediators modulate immune cell activity and reshape tumor behaviors, including proliferation, epithelial-mesenchymal transition, angiogenesis, and metastasis, while immune-derived cytokines can in turn remodel neural circuits and sustain a pro-tumor microenvironment. In this review, we summarize the major mechanisms underlying neuroimmune regulation in breast cancer and discuss emerging therapeutic strategies, including repurposing of neuroactive agents, breast-targeted drug delivery systems, neural stimulation combined with immune checkpoint blockade, and microbiota-neuroimmune interventions. We also outline key challenges to clinical translation, such as the spatiotemporal heterogeneity of neuroimmune regulation, the narrow therapeutic window of neuropharmacological agents, and the lack of standardized biomarkers. CONCLUSION: A deeper understanding of the neuroimmune axis may provide a theoretical basis for precision therapeutic strategies and help improve outcomes, particularly in therapy-resistant subtypes such as triple-negative breast cancer.