From the Guidelines
Pembrolizumab should be administered at a dose of 200 mg intravenously every 3 weeks for a total of 4-8 cycles in the neoadjuvant setting for triple negative breast cancer (TNBC), in combination with chemotherapy, with a total duration of neoadjuvant treatment of approximately 4-6 months before surgery. The chemotherapy regimens commonly used in combination with pembrolizumab include carboplatin and paclitaxel or anthracycline/cyclophosphamide-based combinations 1. This treatment approach is supported by recent guidelines, which recommend the use of pembrolizumab in combination with chemotherapy for the treatment of TNBC, except for some node-negative special histological subtypes or very low clinical risk tumours 1.
Key Considerations
- The use of dose-dense schedules of chemotherapy, with granulocyte colony-stimulating factor support, should be considered given their documented benefit over non-dose-dense schedules 1.
- Patients receiving pembrolizumab should be monitored very closely for the risk of immune-related adverse events throughout treatment and following the ESMO CPG for the management of toxicities from immunotherapy 1.
- After surgery, patients may continue pembrolizumab as adjuvant therapy for up to one year of total treatment, with a recommended duration of nine 3-week cycles during the adjuvant phase, regardless of pCR status 1.
Treatment Monitoring
- Regular laboratory monitoring of thyroid function, liver enzymes, and clinical assessment for immune-related toxicities is essential throughout the treatment course.
- Patients should be monitored for immune-related adverse events during treatment, including thyroid dysfunction, colitis, pneumonitis, and hepatitis.
Recent Study Findings
- A recent study published in Cancer Treatment Reviews found that the addition of pembrolizumab to neoadjuvant chemotherapy resulted in improved outcomes for patients with TNBC, with a pathological complete response (pCR) rate of 64.8% compared to 51.2% for chemotherapy alone 1.
From the Research
Dose and Duration of Pembrolizumab in Neoadjuvant Setting for Triple Negative Breast Cancer
- The dose of pembrolizumab used in the neoadjuvant setting for triple negative breast cancer is 200 mg every 3 weeks 2, 3, 4, 5.
- The duration of pembrolizumab treatment in the neoadjuvant setting is typically 4 cycles, given in combination with chemotherapy such as paclitaxel and carboplatin, followed by 4 cycles of doxorubicin-cyclophosphamide or epirubicin-cyclophosphamide 2, 3, 4, 5.
- After definitive surgery, patients may receive adjuvant pembrolizumab for up to 9 cycles 2, 3, 4, 5.
Efficacy of Pembrolizumab in Neoadjuvant Setting for Triple Negative Breast Cancer
- The addition of pembrolizumab to neoadjuvant chemotherapy has been shown to significantly improve pathological complete response and event-free survival in patients with early-stage triple negative breast cancer 2, 3, 4, 5.
- Pembrolizumab has also been shown to improve overall survival in patients with early-stage triple negative breast cancer 3.
Safety of Pembrolizumab in Neoadjuvant Setting for Triple Negative Breast Cancer
- The safety profile of pembrolizumab in the neoadjuvant setting for triple negative breast cancer is consistent with the established safety profiles of pembrolizumab and chemotherapy 2, 3, 4, 5.
- Treatment-related adverse events of grade 3 or higher have been reported in approximately 50-80% of patients receiving pembrolizumab in combination with chemotherapy 2, 3, 4, 5.