Breast Cancer Clinical Case Review

In this video, Coral Omene, MD, PhD, assistant professor of medicine at Rutgers Robert Wood Johnson Medical School, and program director of Breast Cancer Disparities Research in the division of medical oncology at Rutgers Cancer Institute of New Jersey, presents the treatment options for this case of triple-negative breast cancer.

Editor’s note: The following is an automatically generated transcript of the above video.

“In terms of therapy choices, according to NCCN, the regimens listed, as you can see in this table, are all category 1, and can be given either preoperatively, prior to surgery, or adjuvantly, after surgery. Preferred regimens include dose-dense AC, stands for doxorubicin and cyclophosphamide, followed by taxel, or paclitaxel, which can be given weekly, or in a dose-dense fashion every two weeks.

Regimens also include docetaxel and cyclophosphamide, TC, olaparib, if a germline mutation, or in this case, as highlighted by the blue arrow, which I will focus on, for high-risk triple-negative breast cancer patients, the preoperative pembrolizumab, which is an immunotherapy agent, in combination with chemotherapy, carboplatin plus paclitaxel, followed by a pre-op pembrolizumab, cyclophosphamide, and doxorubicin prior to surgery, and then thereafter, adjuvantly by pembrolizumab alone. This regimen, a more recent regimen that got added to the guidelines a few years ago, was based on a clinical trial, KEYNOTE-522, which we shall discuss.

Why is there an emphasis on the idea of preoperative therapy? Well, for triple-negative breast cancer, this turns out to be very important. There are known benefits for preoperative systemic therapy. Not only does it facilitate breast conservation, it can render inoperable tumors operable, but the treatment response provides important prognostic information at the individual patient level, particularly for patients with triple-negative breast cancer or HER2-positive breast cancer, as you can see by NCCM guidelines. And this is based on actual clinical trial data that has shown us the benefit, and we shall discuss one such clinical trial.

For candidates for preoperative systemic therapy, you can see that for those who are recommended to receive systemic treatment before surgery, they include not only those with inoperable breast cancer, like inflammatory breast cancer, those with bulky or matted N2 axillary lymph nodes, or N3 nodal disease, or T4 size tumors. These patients can also include HER2-positive and triple-negative breast cancer patients.”