SABCS 2022 | The challenges of treating early-stage TNBC
Heather McArthur, MD, MPH, UT Southwestern Medical Center, Dallas, TX, talks on a clinical controversies session at the San Antonio Breast Cancer Symposium (SABCS) 2022 surrounding the challenges associated with treating early-stage triple-negative breast cancer (TNBC) and discusses the new standard-of-care established from the Phase III KEYNOTE-522 (NCT03036488) trial. KEYNOTE-522 had shown statistically significant and clinically meaningful pathological complete response (pCR) and event-free survival (EFS) rates in patients with early triple-negative breast cancer (TNBC) with the addition of pembrolizumab to neoadjuvant chemotherapy. This interview took place at the San Antonio Breast Cancer Symposium (SABCS) 2022 in San Antonio, TX.
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Transcript (edited for clarity)
So they had a new session this year called Clinical Controversies, where we discussed, as a panel, various controversies that are facing us in the treatment of breast cancer. And the one that I was attending to was the challenge of treating patients with triple-negative breast cancer, early-stage disease, and the impact of KEYNOTE-522 becoming a standard of care and how we reconcile all the other data sets with the KEYNOTE-522 data...
So they had a new session this year called Clinical Controversies, where we discussed, as a panel, various controversies that are facing us in the treatment of breast cancer. And the one that I was attending to was the challenge of treating patients with triple-negative breast cancer, early-stage disease, and the impact of KEYNOTE-522 becoming a standard of care and how we reconcile all the other data sets with the KEYNOTE-522 data. So the KEYNOTE 5-22 study, just as a reminder, co-administration of pembrolizumab in the neoadjuvant setting with four different cytotoxic agents and then afterward in the adjuvant setting to complete a year.
And that became the standard of care based on a 3-year event-free survival advantage of 7.7%. So an almost 8% improvement in cure rate as early as three years. The challenge has been in understanding best practice, particularly for patients who do not achieve a pathologic complete response. So those patients seem to derive the most benefit from pembrolizumab access of more than 10%. But what wasn’t permitted on the KEYNOTE-522 experience was co-administration of other drugs that had been really standard of care, like capecitabine and olaparib. So we talked about the CREATE-X data, which led to the standard of care, adjuvant capecitabine administration and subsequent meta-analysis showing an overall-survival advantage, and talked about how we reconciled that with the pembrolizumab data.
We talked about the metastatic setting and how capecitabine and pembrolizumab had been co-administered in that setting without any unexpected safety signals. And so my practice has been to co-administer both drugs in that very high-risk population. And then Dr. Domchek talked about the OlympiA study that led to the standard of care, adjuvant olaparib, so PARP inhibitor administration for high-risk patients with germline BRCA associated tumors. We also have data from the metastatic setting showing that those drugs can be co-administered safely with pembrolizumab. And so that has been a practice that we’ve adopted in that setting.
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