SABCS 2025 | Real-world use, disparities and outcomes of neoadjuvant chemo-IO in TNBC
Inimfon Jackson, MD, MPH, PhD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses real-world adoption and impact of neoadjuvant chemoimmunotherapy (chemo-IO) in early-stage, high-risk triple negative breast cancer (TNBC) using national registry data. The analysis shows rapid uptake over time, improving pathologic complete response rates and increased use of breast-conserving surgery. However, significant disparities in access were observed by race, insurance status, and treatment setting. This interview took place at the San Antonio Breast Cancer Symposium (SABCS) 2025 Meeting in San Antonio, TX.
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Transcript
So our study looking at real-world adoption disparities and impact of neoadjuvant chemoimmunotherapy in patients with high-risk early-stage triple-negative breast cancer was really looking at patients who received neoadjuvant chemotherapy between 2017 to 2022. And the goal was to see the uptake of immunotherapy after its approval based on the Keynote 522 regimen for early-stage high-risk triple-negative breast cancer patients...
So our study looking at real-world adoption disparities and impact of neoadjuvant chemoimmunotherapy in patients with high-risk early-stage triple-negative breast cancer was really looking at patients who received neoadjuvant chemotherapy between 2017 to 2022. And the goal was to see the uptake of immunotherapy after its approval based on the Keynote 522 regimen for early-stage high-risk triple-negative breast cancer patients. So these neoadjuvant, all patients who received neoadjuvant chemotherapy, we looked at those who had immunotherapy as well in this subpopulation. And we saw that the adoption after the approval of the Keynote 522 regimen really went up between 2020 and 2021 up to 2022, while neoadjuvant chemo alone dropped during that same time period. And then we also found that when we looked at factors associated with neoadjuvant chemoimmunotherapy use in this population, patients who, compared to non-Hispanic whites, were black or Hispanic, were less likely to receive neoadjuvant chemoimmunotherapy. We also found that, by insurance, compared to those who had private insurance, patients that had Medicare, Medicaid, or no insurance at all were significantly less likely to receive neoadjuvant chemoimmunotherapy. We looked at the facilities where patients got treatment, and we found that, compared to the more community-based oncology practices, patients who had care at academic facilities were significantly more likely to receive immunotherapy in addition to their neoadjuvant chemotherapy. We also looked at factors associated with pCR in this population. And I think our notable finding there was that even with neoadjuvant chemoimmunotherapy, black patients were significantly less likely to have a pCR. So these findings are interesting. We confirmed that having a pCR was associated with improvement in overall survival. And then basically we found that patients, like when we compared the neoadjuvant chemotherapy to neoadjuvant chemoimmunotherapy, we found that pCR rates over time were higher among those who received immunotherapy.
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