Keytruda/Chemo Combo Is ‘Great News’ for Patients With TNBC, ‘But We Need Much More’

An expert discusses improvements in survival outcomes for patients with triple-negative breast cancer who received Keytruda plus chemotherapy — now considered the standard of care — but urges that more researched is always needed for this patient population.

Patients with previously untreated, locally recurrent, inoperable or metastatic triple-negative breast cancer (TNBC) have a new standard of care with Keytruda (pembrolizumab) when combined with chemotherapy, according to an expert.

Findings demonstrating the improved survival with Keytruda plus chemotherapy were presented at the 2021 San Antonio Breast Cancer Symposium by Dr. Javier Cortés, the head of breast cancer and gynecological cancers at Hospital Universitario Ramón y Cajal, in Madrid.

He explained why the November 2020 approval of Keytruda with chemotherapy was an important step in the right direction, but that providers should consider how to manage side effects in patients on the treatment. He also added that there is still a long way to go for these patients.

“We are improving and increasing overall survival,” Cortés said. “We need more and more drugs, more and more agents in the future, because unfortunately, our patients are still dying. This is still an unmet need. So I think that with patients, we have to say that this is great news, but we need much more.”

Cortés also touched upon the question of whether a patient should go with immunotherapy first or if they can rely on chemotherapy alone. The answer, he said, depends on how much PD-L1 (the protein the Keytruda targets) is expressed on an individual’s cancer cells. Patients and their clinicians should also discuss the potential for immune-related side effects.

“If you have a tumor which expresses PD-L1 … (it) makes sense to decide or at least to think about a (Keytruda)-based combination. If the expression is lower than 10, then maybe this is something that we should not consider,” Cortés said.

Transcription:

So I think (patients) have to know maybe two or three key points, the first one is about the (drug) activity. So do I have to receive a (Keytruda)-based therapy? Or can I go to chemotherapy only? So the answer — unfortunately, this is the only answer we can give today, but it is important. If you have a tumor which expresses PD-L1 expression, (it) makes sense to decide or at least to think about a (Keytruda)-based combination. If the expression is lower than 10, then maybe this is something that we should not consider.

The second aspect is our toxicity. In general, we are talking about all great treatment-emergent (side effects) — they were very, very, very similar between both treatment arms (one given Keytruda plus chemotherapy and the other given only chemotherapy). So we are not going to increase toxicity adding the (Keytruda).

However, we have to consider that in terms of the immune-mediated (side effects), this is something that patients should not have. So we have to understand that that is something that may happen. We have to understand how to manage this toxicity and to explain this to patients properly.

And finally, another aspect is despite that we are improving progression-free survival, we are improving and increasing overall survival. We need more and more drugs, more and more agents in the future, because unfortunately, our patients are still dying, this is still an unmet need. So I think that with patients, we have to say that this is great news, but we need much more.

So of course, I have to say that (when) we have clinical trials, we always have to try to offer the strategy to patients because there's no way to move forward and to improve the patient care.

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