Practice-changing treatment advances continue in early-stage triple-negative breast cancer
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The treatment landscape for early-stage triple-negative breast cancer continues to evolve, according to a speaker at Chemotherapy Foundation Symposium.
However, many questions remain for this population of patients and more clinical trials are always encouraged, Tiffany A. Traina, MD, vice chair of oncology care at Memorial Sloan Kettering Cancer Center, said during a presentation.
Practice-changing data
Traina said KEYNOTE-522 changed practice for patients with triple-negative breast cancer.
“Results of the KEYNOTE-522 study led to the recommendation of neoadjuvant therapy for patients with tumors 2 cm and positive lymph nodes,” she said. “Patients received backbone chemotherapy with the addition of pembrolizumab [Keytruda; Merck] and patients who achieved a pathologic complete response did well.”
However, there is an unmet need among patients with residual disease at the time of surgery, Traina added.
“We do not have all the answers that we would like to have here,” she said. “There are many questions that have been raised, and there are other trials that shed a little bit of light on informing some of those questions. For the smaller tumors that are node-negative, we tend to still favor upfront surgery. We also know that for these women, even if they have small, node-negative tumors, we generally recommend adjuvant chemotherapy and there are still other options to explore.”
PARP inhibitors
The OlympiA trial was another practice-changing trial in this space, according to Traina.
“Results showed significant improvements in invasive disease-free survival with 1 year of adjuvant olaparib [Lynparza; AstraZeneca, Merck], and the treatment was beneficial across the board in subset analyses,” she said. “However, if you remember only one thing about the trial, it should be to have the conversation about genetic testing with your patients. We can’t intervene and we can’t use the right therapeutics if we don’t know the germline BRCA status of our patients.”
Other small, early-stage trials examining the use of poly(ADP-ribose) polymerase (PARP) inhibitor therapies for patients with early-stage triple-negative breast cancer include the NeoTALA and NeoSTAR trials.
“Keep an eye out for data from those ongoing trials and others, including our high-risk patients with residual disease,” Traina said. “There is also another ongoing study that we hope to see data for soon about adjuvant pembrolizumab vs. observation in a subset of patients that did not receive a preoperative checkpoint inhibitor.”
References :
- Schmid P, et al. Abstract GS1-01. Presented at: San Antonio Breast Cancer Symposium (virtual meeting); Dec. 7-10, 2021.
- Traina TA, et al. Early-stage triple-negative breast cancer. Presented at: 40th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow; Nov. 9-11, 2022.
- Tutt A, et al. Abstract VP1-2022. Presented at: ESMO Virtual Plenary; March 16, 2022.
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Traina TA, et al. Early-stage triple-negative breast cancer. Presented at: 40th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow; Nov. 9-11, 2022.
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