An Expert Explains the Three Major Treatment Modalities in Triple Negative Breast Cancer

When it comes to treating triple-negative breast cancer (TNBC), Dr. Howard A. “Skip” Burris, III, explains, there are three key paradigms that doctors often rely on: immunotherapy, targeted biologics such as PARP inhibitors, and antibody-drug conjugates that target the tumor and minimize collateral damage to surrounding tissue.

In an interview with CURE®’s sister publication, OncLive®, Burris, who is also chief medical officer and president of Clinical Operations at Sarah Cannon Research Institute, broke down what’s new and what’s next in each of these areas. Focusing on how newly approved agents like Trodelvy (sacituzumab govitecan) are showing promise for patients with TNBC.

Burris also explained why current clinical trial efforts are focusing on generating better patient outcomes by combining immunotherapy with chemotherapy. While Keytruda (pembrolizumab) has been found particularly effective in this setting, Burris concludes, further study is needed to examine the overall benefits of this approach.

Transcription:

In the field of triple-negative breast cancer, we're beginning to see some remarkable advances, mostly centering around, really the three paradigms that have become so attractive for the treatment of cancer: immunotherapy, targeted biologics in the setting of triple-negative breast cancer (these are the PARP inhibitors, primarily, which are targeting on some specific mutational profiles), and then also, antibody-drug conjugates (the idea of delivering chemotherapy via an antibody, the smart bomb approach, targeting the tumor, minimizing collateral damage, and more effectively delivering a toxin to the cells to create cell death). So, we now have our first approval of a triple-negative antibody-drug conjugate which has generated great excitement, so a lot of promise there.

Also, on the triple-negative front, many of these patients, when they're at an early stage, would benefit from neoadjuvant therapy. Most triple-negative patients, because they're not going to be receiving hormonal therapy, or HER2-based therapy, are going to be candidates for chemotherapy. And so, continuing to work on neoadjuvant strategies remains quite the focus of many trial efforts.

In the area of neoadjuvant therapy, the addition of the checkpoint inhibitors, immunotherapy with chemotherapy, has generated some promising results. We've seen the addition of pembrolizumab in this setting, with some of the clinical trials that have come to date, look quite promising, particularly in terms of looking at deep responses.

Pathological CRs (complete responses0 is right now the current standard, with longer follow up needed to look at overall benefits with regard to how these patients might fare for need of further treatment or not, but really, really interesting in that regard.