вЂњInterestingly, the answer is likely in the impact of treatment by the stage of disease. KEYNOTE-522 also revealed that the benefit of pembrolizumab was amplified in node-positive vs node-negative disease, but the relative impact on event-free survival was independent of nodal status. In KEYNOTE-522, event-free survival and distant recurrenceвЂ“free survival were improved in patients who received pembrolizumab, with absolute differences of almost 8% and 6%, respectively-leading to regulatory approval of pembrolizumab as neoadjuvant followed by adjuvant therapy. The findings also demonstrated that the benefit derived from immunotherapy in early-stage disease is independent of PD-L1 status, although PD-L1вЂ“positive tumors may be more likely to respond. The studies revealed that PD-L1 expression in the tumor predicts for response to chemotherapy, even in the absence of the checkpoint inhibitor. вЂњFrom those initial data we received fascinating information that we had not completely understood before the trials,вЂќ she said. Although adverse events were increased with the checkpoint inhibitor, many patients completed treatment with pembrolizumab and atezolizumab. Patients continued the checkpoint inhibitor for 1 year.Д«oth trials demonstrated a marked improvement in pathologic complete response at the time of surgery. IMpassion031 evaluated atezolizumab given with albumin-bound (nab) paclitaxel followed by doxorubicin and cyclophosphamide. 3 KEYNOTE-522 evaluated pembrolizumab given with carboplatin and paclitaxel followed by an anthracycline and cyclophosphamide. Two pivotal trials that did just that were KEYNOTE-522 2 and IMpassion031. вЂњI think the direction of neoadjuvant therapy now is to replace our adjuvant trials with neoadjuvant trials and power them to look at both pathologic complete response and event-free survival,вЂќ she added. To this end, neoadjuvant immunotherapy is recommended for all but the smallest triple-negative breast tumors, according to Dr. The shift is now to the neoadjuvant setting, where the impact on long-term outcomes will be greater. The power of this combination approach was first proven in the metastatic setting. Chemotherapy can further boost the action of immunotherapy by inducing immunomodulatory changes in the tumor microenvironment. Triple-negative tumors seem to be good targets for immunotherapy because of their high mutation rate, expression of PD-L1, and presence of tumor-infiltrating lymphocytes. вЂњItвЂ™s particularly important to optimize our therapy while still trying to individualize it,вЂќ Dr. 1 The Giants of Cancer Care recognition program celebrates the achievements of experts whose discoveries have propelled the field of oncology forward and established the building blocks for future advances.ДЄlthough this subtype is heterogeneous, triple-negative breast cancer generally carries a high risk of recurrence within 2 to 3 years. Rugo, MD, FASCO, Professor of Medicine and Director of Breast Oncology and Clinical Trials Education at the University of California San Francisco Helen Diller Family Comprehensive Cancer Center. This exciting field of breast cancer research was explored at the 2022 Miami Breast Cancer Conference by Giants of Cancer Care В® honoree Hope S. Immunotherapy has become a potential strategy in treating triple-negative breast cancer, though many questions remain to be answered before long-term survival is achieved by all patients.

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