Dr. Rugo on Recent Updates With Immunotherapy in TNBC

Hope S. Rugo, MD, a professor in the Department of Medicine, Hematology/Oncology, and director, Breast Oncology and Clinical Trials Education, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses recent updates with immunotherapy in triple negative breast cancer (TNBC).

It is a really exciting time in breast cancer, says Rugo. Many advances have been made in the immuno-oncology space in a disease where no good treatment options have been available. The breast cancer field is finally seeing some progress made. The combination of atezolizumab (Tecentriq) plus nab-paclitaxel (Abraxane) was FDA approved for use as a first-line therapy for patients with metastatic PD-L1–positive TNBC who are at least 1 year out from their adjuvant or neoadjuvant taxane. The approval was based on data from the phase 3 IMpassion130 trial. Many patients in that trial had de novo metastatic disease.

Results showed a significant improvement in progression-free survival (PFS), although modest, around 2 months, but a marked 7-month difference in overall survival in the 41% of patients who had PD-L1–positive disease using an antibody called SP142. These are very exciting data, because it is the first and only checkpoint inhibitor approved in the treatment of patients with TNBC, Rugo adds.

This trial demonstrated that some criteria need to occur in order to see checkpoint inhibitor efficacy in those with metastatic disease and also brings to light the issue of which chemotherapy partner should be used. A lot has been learned about toxicity and managing adverse events, as well as increased awareness of immune-related toxicities because breast cancer was relatively late to the field, concludes Rugo.