Top Line: Today we are delving more into chemoimmunotherapy as the new standard of care for stage II-III triple-negative breast cancer.
The Study: By now you’ve surely seen neoadjuvant chemoimmunotherapy for these women in your clinic based on interim reporting of KEYNOTE-522 demonstrating improved event-free survival with the addition of pembro to platinum-based chemo a couple of years ago. The final reporting is now here confirming an improvement in overall survival. As a reminder, 1174 women with cT1cN1–2 or cT2+N0–2 triple-negative breast cancer receiving neoadjuvant carbo/Taxol q3 weeks x 4 → Adria/cyclophosphamide q3 weeks x 4 were randomized 2:1 to the addition of pembro versus placebo with each cycle. Those in the pembro arm received additional post-op pembro q3 weeks x 9. As hoped, overall survival at 5 years was significantly improved from 82 → 87% with the addition of pembro. With a median follow-up surpassing 6 years, disease progression remained slashed by one-third. Serious treatment-related adverse events were also increased 20 → 34%, and it’s worth noting here that the only subgroup without apparent benefit from this intense systemic therapy regimen were those 65 years and older. Not to diminish this truly landmark victory, we’ll pause here to recognize what a woman with a 2.1 cm node-negative triple-negative breast cancer is now in for per NCCN: upfront quintuple-agent chemoimmunotherapy for 6 months followed by surgery +/- RT followed by 6 more months of immunotherapy and possibly a year of olaparib if found to have a BRCA mutation.
TBL: A total of one year of five-agent chemoimmunotherapy straddling surgery is now standard of care for women with stage II-III triple-negative breast cancer. | Schmid, N Engl j Med 2024
The Study: By now you’ve surely seen neoadjuvant chemoimmunotherapy for these women in your clinic based on interim reporting of KEYNOTE-522 demonstrating improved event-free survival with the addition of pembro to platinum-based chemo a couple of years ago. The final reporting is now here confirming an improvement in overall survival. As a reminder, 1174 women with cT1cN1–2 or cT2+N0–2 triple-negative breast cancer receiving neoadjuvant carbo/Taxol q3 weeks x 4 → Adria/cyclophosphamide q3 weeks x 4 were randomized 2:1 to the addition of pembro versus placebo with each cycle. Those in the pembro arm received additional post-op pembro q3 weeks x 9. As hoped, overall survival at 5 years was significantly improved from 82 → 87% with the addition of pembro. With a median follow-up surpassing 6 years, disease progression remained slashed by one-third. Serious treatment-related adverse events were also increased 20 → 34%, and it’s worth noting here that the only subgroup without apparent benefit from this intense systemic therapy regimen were those 65 years and older. Not to diminish this truly landmark victory, we’ll pause here to recognize what a woman with a 2.1 cm node-negative triple-negative breast cancer is now in for per NCCN: upfront quintuple-agent chemoimmunotherapy for 6 months followed by surgery +/- RT followed by 6 more months of immunotherapy and possibly a year of olaparib if found to have a BRCA mutation.
TBL: A total of one year of five-agent chemoimmunotherapy straddling surgery is now standard of care for women with stage II-III triple-negative breast cancer. | Schmid, N Engl j Med 2024