eCase - ICIs for EBC

Introduction

In this case-based module, Tanya Gupta, MD, reviews important data and guidance on leveraging immune checkpoint inhibitor (ICI)–based therapy for treatment of early-stage triple-negative breast cancer (TNBC), along with a brief overview of ICI-based regimens under phase III investigation in other settings.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Two questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

For those providing patient care, how many patients with breast cancer do you provide care for in a typical month?

A.
1-5
B.
6-10
C.
11-15
D.
16-20
E.
>20

A 52-year-old woman presents with cT2N1M0 TNBC, with imaging demonstrating a 4.5-cm tumor and 2 suspicious lymph nodes. Biopsy of the breast and lymph node demonstrates invasive ductal carcinoma, grade 3, with a Ki-67 score of 30%. Germline BRCA testing is negative. She receives neoadjuvant therapy with carboplatin/paclitaxel/pembrolizumab followed by doxorubicin/cyclophosphamide/pembrolizumab. She then undergoes a lumpectomy and axillary surgery, with surgical pathology demonstrating a pathologic complete response (pCR). The patient presents to discuss adjuvant therapy options.

Based on current standard of care, which of the following adjuvant therapy options would you recommend for this patient?

A.
Abemaciclib
B.
Olaparib
C.
Pembrolizumab
D.
No adjuvant therapy

A patient with early-stage TNBC and which of the following characteristics would be a candidate for the ongoing OptimICE-PCR trial?

A.
History of cardiovascular disease, interested in anthracycline-free neoadjuvant therapy
B.
History of diabetes with neuropathy, interested in taxane-free neoadjuvant therapy
C.
Residual disease present following neoadjuvant chemotherapy plus pembrolizumab
D.
No residual disease following neoadjuvant chemotherapy plus pembrolizumab

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Immune Checkpoint Inhibitor Therapy for HER2-Negative Early-Stage Breast Cancer

Tanya Gupta, MD

Activity

Introduction

For those providing patient care, how many patients with breast cancer do you provide care for in a typical month?

Based on current standard of care, which of the following adjuvant therapy options would you recommend for this patient?

A patient with early-stage TNBC and which of the following characteristics would be a candidate for the ongoing OptimICE-PCR trial?