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Managing TNBC

CE / CME

Cases and Challenges in the Optimal Treatment of Triple-Negative BC

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurse Practitioners: 1.00 Nursing contact hours, includes 1.00 hour of pharmacotherapy credit

Released: May 08, 2023

Expiration: May 07, 2024

Jeremy M. Force
Jeremy M. Force, DO
CME/CE Information

Activity

Progress
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Course Completed

Updated Guidance in Early-Stage TNBC

The results of KEYNOTE-522 revolutionized management of early breast cancer for patients with stage II/III high-risk TNBC. In this study, pembrolizumab or placebo was added to standard neoadjuvant treatment with paclitaxel plus carboplatin for 4 cycles followed by pembrolizumab or placebo combined with 4 cycles of anthracycline and cyclophosphamide. After definitive surgery, patients then received adjuvant pembrolizumab or placebo for up to 9 cycles.14 Achievement of pCR with neoadjuvant therapy is considered a predictor of good prognosis, and more patients achieved pCR with added pembrolizumab (64.8%) than chemotherapy alone (51.2%); benefit with pembrolizumab was seen independent of the level of PD-L1 expression.14,15 A significant improvement in event-free survival, also independent of PD-L1 expression, was seen with pembrolizumab (Figure 1), and estimated 36-month OS was 89.7%. Other OS data are still immature.15

Figure 1. KEYNOTE-522: event-free survival with perioperative pembrolizumab vs placebo in stage II/III high-risk TNBC.14,15

Figure 1

 

Neoadjuvant pembrolizumab followed by adjuvant pembrolizumab is now recommended by the NCCN for high-risk early TNBC with any level of PD-L1 expression, and is also FDA approved for this use.10,16,17 The pembrolizumab combination can be given concurrently with olaparib for patients with germline BRCA-mutated disease.10

 

Expert Insights From Dr Force: Perioperative Pembrolizumab and Survival

 

Another advance in management of early high-risk breast cancer is use of an adjuvant PARP inhibitor for HER2-negative, BRCA1/2-mutated disease, based on results of the phase III OlympiA trial. In this study, patients received 1 year of adjuvant olaparib or placebo after (neo)adjuvant chemotherapy and definitive surgery. With long-term follow-up, adjuvant olaparib was associated with improved OS at 3 years (HR for death: 0.68; 95% CI: 0.44-1.05; P = .02) and improved distant disease-free survival (HR: 0.57; 95% CI: 0.39-0.83; P <.001).18 One year of adjuvant olaparib is now recommended for patients with BRCA-mutated, HER2-negative early disease, and is also FDA approved for this use.10,19

How often should thyroid levels be assessed in patients being treated with pembrolizumab or another ICI?

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