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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
1
Course Completed

Metastatic TNBC: First Line

Until recently, first-line treatment for metastatic TNBC was limited to chemotherapy. The results of KEYNOTE-355 led NCCN and ASCO to update their recommendations to include pembrolizumab in combination with chemotherapy for patients with PD-L1-positive disease defined as CPS ≥10.10,16 The trial compared addition of pembrolizumab or placebo to investigator’s choice of chemotherapy regimen (carboplatin plus nab-paclitaxel, paclitaxel, or gemcitabine) for patients with previously untreated, unresectable, locally advanced or metastatic TNBC. Primary endpoints for the study were progression-free survival (PFS) and OS.28 In the final analysis of the trial at a median of 44.1 months of follow-up, addition of pembrolizumab was associated with improved OS and PFS, and a higher response rate (Figure 2).25 A subgroup analysis found that pembrolizumab improved PFS regardless of the chemotherapy used.28 However, unlike in early breast cancer where benefit was found independent of PD-L1 expression, in metastatic TNBC improved survival vs chemotherapy alone was observed only in patients with PD-L1 CPS ≥10.25 Pembrolizumab in combination with chemotherapy is FDA approved for treatment of locally recurrent unresectable or metastatic TNBC whose tumors express PD-L1 (CPS ≥10).17

Figure 2. Final analysis of KEYNOTE-355: Improved OS with addition of pembrolizumab in patients with metastatic TNBC and PD-L1 CPS≥1028,29

 

Expert Insights From Dr Force: Selecting a Chemotherapy Backbone With Pembrolizumab

 

What is a recommended next step for patients with metastatic, BRCA-negative TNBC and progression on first-line therapy?

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