From the Guidelines
The American Society of Clinical Oncology (ASCO) guidelines recommend the use of immunotherapy in triple-negative breast cancer (TNBC) with the addition of immune checkpoint inhibitors, such as atezolizumab or pembrolizumab, to chemotherapy for patients with metastatic disease and PD-L1 expression on tumor-infiltrating immune cells 1.
Key Points
- The recommended treatment is the addition of immune checkpoint inhibitor to chemotherapy, such as atezolizumab plus nab-paclitaxel or pembrolizumab plus chemotherapy, as first-line therapy for patients with PD-L1-positive TNBC 1.
- Patients with triple-negative, PD-L1-negative MBC should be offered single-agent chemotherapy rather than combination chemotherapy as first-line treatment, although combination regimens may be offered for life-threatening disease 1.
- The use of immunotherapy in TNBC has shown promising results, with improved progression-free survival (PFS) and overall survival (OS) in patients with PD-L1-positive disease 1.
Treatment Details
- The dose and schedule of atezolizumab and pembrolizumab may vary, but atezolizumab is typically administered at a dose of 840mg intravenously every 2 weeks, in combination with nab-paclitaxel 100mg/m² on days 1,8, and 15 of a 28-day cycle 1.
- Treatment should continue until disease progression or unacceptable toxicity, with ongoing assessment of response and tolerance 1.
Important Considerations
- The ASCO guidelines recommend that patients with triple-negative MBC who have received at least two prior therapies for MBC should be offered treatment with sacituzumab govitecan 1.
- Patients with triple-negative MBC with germline BRCA mutations previously treated with chemotherapy may be offered a poly (ADP-ribose) polymerase inhibitor rather than chemotherapy 1.
From the Research
American Society of Clinical Oncology (ASCO) Guidelines for Immunotherapy in Triple-Negative Breast Cancer (TNBC)
- The ASCO guidelines recommend atezolizumab plus nab-paclitaxel for first-line treatment of unresectable, locally advanced, or metastatic TNBC expressing programmed death-ligand 1 (PD-L1) on tumor-infiltrating immune cells (IC) 2, 3.
- For patients with TNBC who have unknown PD-L1 status, or if PD-L1-positive and immunotherapy is unavailable, single-agent chemotherapy is recommended 4.
- The guidelines also suggest that neoadjuvant therapy can be used to reduce the extent of local therapy or reduce delays in initiating therapy, but there is currently insufficient evidence to support adding immune checkpoint inhibitors to standard chemotherapy for TNBC 5.
Key Recommendations
- Atezolizumab plus nab-paclitaxel is recommended for first-line treatment of unresectable, locally advanced, or metastatic TNBC with PD-L1-positive tumor-infiltrating immune cells 2, 3.
- Single-agent chemotherapy is recommended for patients with TNBC who have unknown PD-L1 status, or if PD-L1-positive and immunotherapy is unavailable 4.
- Neoadjuvant therapy can be used to reduce the extent of local therapy or reduce delays in initiating therapy, but immune checkpoint inhibitors are not currently recommended for addition to standard chemotherapy for TNBC 5.