Topics:
Breast Cancer • Medical Oncology • Immunotherapy • Triple negative • Journal Club ft. NEJM publications • BRCA+ • Breast Cancer, Non-metastatic
In patients who receive neoadjuvant pembrolizumab and chemotherapy for TNBC, how will you manage adjuvant treatment if they have a germline BRCA mutation?
Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence?
Answer from: Medical Oncologist at Academic Institution
Olaparib is not approved for use as adjuvant therapy for breast cancer. If the patient was treated with NAC and pembrolizumab, I would continue pembrolizumab in the adjuvant setting, per published and FDA-approved protocol. It is not yet known whether patients who are treated with NAC and pembrolizu...
Answer from: Medical Oncologist at Academic Institution
Based on the KEYNOTE-522 study, neoadjuvant pembrolizumab with chemotherapy followed by adjuvant pembrolizumab for triple negative breast cancer patients with either a more than 2 cm primary or lymph node positive disease became standard of care. Based on the updated results from the study (ESMO 202...
Answer from: Medical Oncologist at Community Practice
The rate of pathologic complete response with chemotherapy is higher in gBRCA1m and/or gBRCA2m carriers with TNBC than in nonmutation carriers. The results of the KEYNOTE-522 trial by BRCA status are not available. One might first question the role of neoadjuvant pembrolizumab in this setting. Howev...
Medical Oncologist
Both
I concur with the discussion by @Sagar D. Sardesai...
Great review!