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Applying IMpassion130 Data to TNBC Management

Insights From: Tiffany Traina, MD, Memorial Sloan Kettering Cancer Center
Published: Monday, Apr 29, 2019


Transcript:

Tiffany Traina, MD:
I think these data and the FDA approval for atezolizumab, partnered with nab-paclitaxel [nanoparticle albumin-bound paclitaxel] have really been practice changing. So it has changed my practice in that I feel it’s important to know the PD-L1 [programmed death-ligand 1] status for my patients with metastatic triple-negative breast cancer. The FDA label for atezolizumab allowed for its use in patients with PD-L1 positivity but was mum on the assay to be used. I think we need to be cautious about that, recognizing that the assay use in IMpassion130 involves a Ventana antibody SP142. So 1 thing I think is very important to take away is that oncologists are having conversations with their local pathologists and laboratories to understand how PD-L1 testing is being performed. That enables us to then translate those IMpassion130 results into our clinic. So No 1, it’s important to know the PD-L1 status for our patients with metastatic triple-negative breast cancer. However, there’s still a tremendous unmet need for the additional 60% of patients who will test PD-L1 negative.

One takeaway that I’ve had is the results of IMpassion130 were in the first-line setting, where we’ve seen such compelling results. And if we look across the trials that have been available thus far of these 2 studies that have been reported, the greatest benefit really seems to be in the earliest line. So 1 takeaway for me is to understand what a patient’s PD-L1 tumor status is right at the diagnosis of metastatic triple-negative breast cancer. And if appropriate, try to use that checkpoint blockade early and not wait till later lines, where I think phase II studies would suggest the benefit just may not be there.

Adverse events are an important component in our treatment choice and recommendation. So in the IMpassion130 study, women who had underlying diagnoses of autoimmune conditions were excluded from this study to begin with. And autoimmune adverse events are concerning when they are challenging to treat. So hypothyroidism can be managed. But having an awareness of the risk of hepatitis or pneumonitis requiring swift corticosteroid intervention are important, as well as different adverse event profiles for oncologists to become comfortable with managing for our patients.

Transcript Edited for Clarity.
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Transcript:

Tiffany Traina, MD:
I think these data and the FDA approval for atezolizumab, partnered with nab-paclitaxel [nanoparticle albumin-bound paclitaxel] have really been practice changing. So it has changed my practice in that I feel it’s important to know the PD-L1 [programmed death-ligand 1] status for my patients with metastatic triple-negative breast cancer. The FDA label for atezolizumab allowed for its use in patients with PD-L1 positivity but was mum on the assay to be used. I think we need to be cautious about that, recognizing that the assay use in IMpassion130 involves a Ventana antibody SP142. So 1 thing I think is very important to take away is that oncologists are having conversations with their local pathologists and laboratories to understand how PD-L1 testing is being performed. That enables us to then translate those IMpassion130 results into our clinic. So No 1, it’s important to know the PD-L1 status for our patients with metastatic triple-negative breast cancer. However, there’s still a tremendous unmet need for the additional 60% of patients who will test PD-L1 negative.

One takeaway that I’ve had is the results of IMpassion130 were in the first-line setting, where we’ve seen such compelling results. And if we look across the trials that have been available thus far of these 2 studies that have been reported, the greatest benefit really seems to be in the earliest line. So 1 takeaway for me is to understand what a patient’s PD-L1 tumor status is right at the diagnosis of metastatic triple-negative breast cancer. And if appropriate, try to use that checkpoint blockade early and not wait till later lines, where I think phase II studies would suggest the benefit just may not be there.

Adverse events are an important component in our treatment choice and recommendation. So in the IMpassion130 study, women who had underlying diagnoses of autoimmune conditions were excluded from this study to begin with. And autoimmune adverse events are concerning when they are challenging to treat. So hypothyroidism can be managed. But having an awareness of the risk of hepatitis or pneumonitis requiring swift corticosteroid intervention are important, as well as different adverse event profiles for oncologists to become comfortable with managing for our patients.

Transcript Edited for Clarity.
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