[Correspondence] Pembrolizumab plus chemotherapy in triple-negative breast cancer

We read with great interest the practice-changing results of the KEYNOTE-355 trial by Javier Cortes and colleagues,Cortes J Cescon DW Rugo HS et al.Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial. who showed the efficacy of adding pembrolizumab to standard chemotherapy in patients with PD-L1-positive metastatic triple-negative breast cancer.One feature of this study is the inclusion of patients with early recurrences (between 6 months and 12 months following completion of perioperative chemotherapy), which are common in triple-negative breast cancer. In clinical practice, taxane-containing regimens are commonly used as a perioperative treatment for triple-negative breast cancer,Burstein HJ Curigliano G Loibl S et al.Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. so clinical trials to evaluate the efficacy of taxane-containing regimens for metastatic triple-negative breast cancer generally do not include patients with early recurrence, which is considered taxane resistant. In fact, in the IMpassion130 trial, which showed the efficacy of atezolizumab plus nab-paclitaxel for PD-L1-positive triple-negative breast cancer, patients with early recurrence were excluded, so data on the efficacy of the combination of immunotherapy plus chemotherapy in these patients are scarce.Schmid P Adams S Rugo HS et al.Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer.Schmid P Rugo HS Adams S et al.Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable, locally advanced or metastatic triple-negative breast cancer (IMpassion130): updated efficacy results from a randomised, double-blind, placebo-controlled, phase 3 trial. Meanwhile, in the KEYNOTE-355 trial, patients with early recurrence could be enrolled if they chose a different class of chemotherapy, including platinum or taxane, from perioperative treatment. 176 (21%) of all 847 patients enrolled in this study had early relapse with a disease-free interval of less than 12 months, but data on the patients' details were not shown. We encourage the investigators to consider reporting these patients' characteristics and which chemotherapy was chosen as the study treatment. This information is useful for clinicians to formulate the combination of immunotherapy plus chemotherapy in patients with early-relapse triple-negative breast cancer.A summary of competing interests is available in the appendix.Supplementary MaterialReferences1.Cortes J Cescon DW Rugo HS et al.

Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial.

Lancet. 396: 1817-18282.Burstein HJ Curigliano G Loibl S et al.

Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019.

Ann Oncol. 30: 1541-15573.Schmid P Adams S Rugo HS et al.

Atezolizumab and nab-paclitaxel in advanced triple-negative breast cancer.

N Engl J Med. 379: 2108-21214.Schmid P Rugo HS Adams S et al.

Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable, locally advanced or metastatic triple-negative breast cancer (IMpassion130): updated efficacy results from a randomised, double-blind, placebo-controlled, phase 3 trial.

Lancet Oncol. 21: 44-59Article InfoPublication HistoryIdentification

DOI: https://doi.org/10.1016/S0140-6736(21)00380-9

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