What adjuvant therapy would you offer for node-negative TNBC with 0.6 cm residual disease (RCB-II) after neoadjuvant docetaxel/carboplatin/pembrolizumab?
Would you complete adjuvant AC/pembro x4c before capecitabine, or proceed directly to pembrolizumab + capecitabine? Tumor was initially 2.1cm and treated per the SCARLET trial. Surgical pathology showed 0.6 cm residual disease (20% cellularity, RCB-II).
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What adjuvant therapy would you offer a 60-year-old with initially 2.1 cm, node-negative TNBC and 0.6 cm residual disease (RCB-II) after neoadjuvant docetaxel/carboplatin/pembrolizumab?
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2 Answers
Mednet MemberInvited Expert
Medical Oncology · Ohio State University
Answered on
You can go either way here. However, since 6 cycles of docetaxel, carboplatin, and pembrolizumab are being compared to the entire KEYNOTE-522 regimen, I would lean towards proceeding with 6-8 cycles of capecitabine and continuing pembrolizumab to complete 1 year of treatment with this agent.
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Mednet MemberInvited Expert
Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on · Updated on
There is no trial or guideline basis for retrofitting an anthracycline in this patient who was deliberately spared on the anthracycline-free NeoPACT/SCARLET backbone, and doing so adds cardiac and leukemogenic risk without demonstrated benefit (Sharma et al., PMID 37991778; Song et al., PMID 3819811...
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