Choice of chemotherapy is important in 1L treatment with immunotherapy for triple-negative breast cancer

Best Practice Nordic | Syys 2020 | ESMO 2020 |

Positive results with immunotherapy in combination with the chemotherapy nab paclitaxel in 1st line treatment of triple-negative and PD-L1-positive metastatic breast cancer. Disappointing results with the combination with paclitaxel suggest that the choice of chemotherapy is of great importance. Updated results from the phase III study IMpassion130, where atezolizumab was given in combination with nab-paclitaxel, and new data from IMpassion131, where chemotherapy was changed to paclitaxel, were presented at this year’s virtual ESMO Congress 2020. As early as January, the Danish Medicines Agency recommended that patients with triple-negative breast cancer should be treated with atezolizumab in combination with nab paclitaxel on the basis of positive results in the IMpassion130 study. Quite unexpectedly, IMpassion131 showed no effect of adding atezolizumab to paclitaxel. With the same study design and comparable patient population in the studies, a number of questions arise. Is it due to the choice of chemotherapy and thus differences in the premedication, different in the patient population or is it just a coincidence? Follow the discussion on why the studies turned out differently when Lisa Carey, Chapel Hill, USA, perspectives the two studies and incorporates results from Keynote 355, where pembrolizumab was given in combination with different chemotherapies also in 1L line triple-negative breast cancer. The results were presented at ASCO earlier this year. Find more information: LBA15 – Primary results from IMpassion131, a double-blind placebo-controlled randomised phase III trial of first-line paclitaxel (PAC) ± atezolizumab (atezo) for unresectable locally advanced/metastatic triple-negative breast cancer (mTNBC). LBA16 – IMpassion130: Final OS analysis from the pivotal phase III study of atezolizumab + nab-paclitaxel vs placebo + nab-paclitaxel in previously untreated locally advanced or metastatic triple-negative breast cancer. See Lisa Carey discuss the two studies. Abstract from ASCO 2020: KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy...