How do you select first-line therapy for PD-L1-positive metastatic TNBC?

At this point, we only have mature data on pembro and SG, and this is the regimen I would use.

I would select an anti-TROP2 antibody-drug conjugate (ADC) as first-line therapy irrespective of the PD-L1 combined positive score (CPS), for two reasons.

First, the large majority of these patients will have been exposed to multi-agent chemotherapy combined with immune checkpoint blockade during neo...

For patients with PD-L1 CPS greater than 10, regardless of germline BRCA1/2 pathogenic variant status, my first-line treatment of choice is pembrolizumab combined with sacituzumab govitecan (SG) or chemotherapy based on the ASCENT-04 trial. In ASCENT-04, SG plus pembrolizumab improved median progres...

Regardless of germline BRCA1/2 pathogenic variant status, the two category 1, preferred first-line NCCN recommendations are either Sacituzumab govitecan + pembrolizumab or chemotherapy + pembrolizumab — chemotherapy options include albumin-bound paclitaxel, gemcitabine/carboplatin, or paclitaxel.

Th...