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BCC 2021 | Treatment advances in TNBC

Giuseppe Curigliano, MD, PhD, University of Milan, Milan, Italy, provides an update on treatment approaches for triple-negative breast cancer (TNBC), including the findings of the Phase III OlympiA trial (NCT02032823), evaluating olaparib, a PARP inhibitor, as adjuvant treatment in patients with germline BRCA mutated, high risk, triple-negative breast cancer. In this patient population, olaparib demonstrated improvements in invasive disease-free survival. Prof. Curigliano also talks on the ongoing SASCIA study (NCT04595565), a Phase III prospective, randomized trial where patients with TNBC with residual disease following neoadjuvant chemotherapy are treated with physicians’ choice or eight cycles of sacituzumab govitecan, an antibody-drug conjugate. Lastly, Prof. Curigliano highlights the use of immune checkpoint inhibitors pembrolizumab and atezolizumab in combination with chemotherapy in the neoadjuvant setting of TNBC which was shown to improve the pathological complete response. This interview took place during the 17th St. Gallen International Breast Cancer Conference.

Transcript (edited for clarity)

We have many new agents under development in the adjuvant setting. Recently the data of OlympiA have been announced as a positive trial. The OlympiA trial randomized patients with triple negative breast cancer and residual disease following neoadjuvant chemotherapy to receive olaparib for one year or observation. This trial was designed specifically for patients with BRCA germline mutation. And we know already from the press release that there is an improvement in the invasive disease-free survival in the treatment arm with olaparib...

We have many new agents under development in the adjuvant setting. Recently the data of OlympiA have been announced as a positive trial. The OlympiA trial randomized patients with triple negative breast cancer and residual disease following neoadjuvant chemotherapy to receive olaparib for one year or observation. This trial was designed specifically for patients with BRCA germline mutation. And we know already from the press release that there is an improvement in the invasive disease-free survival in the treatment arm with olaparib. We don’t know the magnitude of benefit but it is accepted that in a few months, we will have a new treatment option in the adjuvant setting.

I discussed also about the trial SASCIA, that is a prospective randomized trial for patients with triple negative breast cancer and residual disease following neoadjuvant chemotherapy that would be randomized to capecitabine treatment or physician choice versus sacituzumab govitecan that is an antibody-drug conjugate, that specifically target an antigen named Trop-2.

So I must confess that many new agents are under development in this field both in the post-neoadjuvant setting, but also in the neoadjuvant. This year, as you know, we had the data of two prospective randomized trial using atezolizumab or pembrolizumab in combination with chemotherapy in the neoadjuvant setting. Both immune checkpoint inhibitors increased the pCR rate, both in the trial with pembro plus chemotherapy and in the other trial with atezolizumab plus chemotherapy.

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