Dr Huppert on Data Informing the Sequence of Systemic Therapy in Early-Stage TNBC

Laura A. Huppert, MD, breast medical oncologist, assistant professor, University of California, San Francisco School of Medicine, discusses key data informing the optimal sequence of immunotherapy, PARP inhibitors, and traditional chemotherapy regimens in the treatment of patients with early-stage triple-negative breast cancer (TNBC).

The necessity of adjuvant pembrolizumab (Keytruda) for patients with early-stage TNBC achieving a pathologic complete response (pCR) after neoadjuvant therapy remains uncertain, Huppert begins.

Currently, the standard of care is to continue treatment with pembrolizumab based on the phase 3 KEYNOTE-522 trial (NCT03036488), Huppert continues, adding that this study demonstrated the benefit of neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab in early-stage disease. However, the necessity of adjuvant pembrolizumab may be re-evaluated based on data from ongoing trials, she notes.

Accordingly, ongoing studies such as the phase 3 OptimICE-PCR trial (NCT05812807) aim to address this question, she states. This trial will randomly assign patients who achieve pCR after neoadjuvant pembrolizumab to either continue pembrolizumab for 1 year or undergo observation, providing valuable data on the role of adjuvant pembrolizumab in this setting.

Data from the interim analysis of the phase 3 IMpassion030 trial (NCT03498716), which evaluated the addition of adjuvant-only atezolizumab (Tecentriq) to standard chemotherapy originally in patients with stage II or III disease who underwent surgery prior to immunotherapy, Huppert details. Findings suggested no additional benefit in invasive disease-free survival compared with chemotherapy alone. This highlights the importance of neoadjuvant immunotherapy in optimizing outcomes for patients with stage II or III disease, Huppert explains.

Optimally staging patients is crucial to ensure they receive appropriate neoadjuvant treatment, Huppert adds. If a patient undergoes surgery first, the data from IMpassion030 suggests that adding adjuvant immunotherapy based solely on this approach may not provide additional benefit. Therefore, treatment decisions should be individualized based on each patient's specific clinical scenario and available data, Huppert concludes.