Metastatic Triple Negative Breast Cancer: IMpassion130 - Episode 9

TNBC: Using Checkpoint Inhibitors Alone or With Chemotherapy


Tiffany A. Traina, MD: There have been several trials now that have explored the addition of checkpoint inhibitors in breast cancer, either as monotherapy or in combination with chemotherapy. In looking at the composite of these data that are now available to us, I think it's fair to say that checkpoint inhibitors as monotherapy have modest benefit. The greatest benefit appears to be when checkpoint inhibitors are added to systemic chemotherapy, and potentially even when added to radiation therapy.

My takeaway in reviewing these data is that combination therapy of a checkpoint inhibitor with chemotherapy offers advantage. Utilizing this combination in the earliest lines of therapy, such as first-line triple-negative breast cancer, is advantageous over saving this therapy for a later line, where the benefits do not appear to stand up.

In my practice for patients with advanced triple-negative breast cancer, I tend to utilize sequential single-agent chemotherapy. I wouldn't consider doublet chemotherapy, if you will. The addition of a checkpoint inhibitor for me is often to single-agent chemotherapy. There are places, perhaps, where we look at doublet chemotherapy, such as with the combination of carboplatin and gemcitabine.

We know that combination chemotherapy may offer a higher response rate. It has not borne out to show that combination chemotherapy improves overall survival. We know that toxicity is sometimes more challenging and more difficult to manage. The setting in which we may use doublet chemotherapy is for those patients who need a rapid and profound response. But then, oftentimes, I will drop one agent and proceed with single-agent chemotherapy; and then, if appropriate, continue with a checkpoint inhibitor.

Transcript Edited for Clarity