Is there a role for adjuvant pembrolizumab/capecitabine in a patient with TNBC who receives neoadjuvant AC-T with residual disease found at time of surgery?

Topics: Breast Cancer • Medical Oncology • Breast Cancer, Non-metastatic

Answer from: Medical Oncologist at Academic Institution

Based on CREATE-X, there would be data to support using adjuvant capecitabine in this scenario. As for pembrolizumab, there is emerging data that the benefit of the checkpoint inhibitor may be limited to the neoadjuvant setting based on the recent negative IMpassion030 trial of adjuvant atezolizumab...

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Medical Oncologist at NYU Winthrop Hospital
I agree. For residual disease, I prefer capecitab...

Answer from: Medical Oncologist at Community Practice

I would not offer immune checkpoint inhibitor in this setting. The ALEXANDRA/IMpasssion 030 trial of adjuvant atezolizumab, presented at SABCS 2023, was essentially negative. SWOG 1418 has been closed to accrual for a while now, and given that this is an event-driven trial, it makes me speculate tha...

Answer from: Medical Oncologist at Academic Institution

This is an interesting question. Why should NAT with pembrolizumab work to improve pCR and EFS in KN 522, but atezoliuzmab not work as adjuvant therapy in IMpassion030 (as noted below in an SABCS 23 presentation)? Could it be the choice of checkpoint inhibitor? We can only speculate on S1418 (adjuva...

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Medical Oncologist at H Lee Moffitt Cancer Center, University of South Florida
Good question @Adam. May be that atezolizumab bloc...

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