Advancing immunotherapy for early-stage triple-negative breast cancer
Mené dans 13 pays sur 333 patientes atteintes d’un cancer du sein triple négatif de stade précoce, cet essai de phase III évalue l’efficacité, du point de vue du taux de réponse pathologique complète, et la toxicité de l’ajout de l’atézolizumab à une chimiothérapie néoadjuvante à base de nab-paclitaxel, doxorubicine et cyclophosphamide (durée médiane de suivi : 20,6 mois)
Neoadjuvant chemotherapy is increasingly used in early-stage triple-negative breast cancer given that chemotherapy is inevitable and tumour response assessment from surgical specimens provides prognostic information. 1 A US Food and Drug Administration supported meta-analysis showed that patients with no evidence of invasive cancer in the breast and axillary nodes (pathological complete response) have significantly improved event-free survival and overall survival. 2 The standard neoadjuvant chemotherapy for triple-negative breast cancer is combined anthracyclines and cyclophosphamide, and taxane-based regimens. These regimens induce a pathological complete response of approximately 40%; added to platins, which are not yet widely recommended, pathological complete response can reach 50%, albeit with increased toxicity. 3 The treatment landscape is changing with the development of immune checkpoint inhibitors, including programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1). Triple-negative breast cancer is ideal for immune checkpoint inhibitors because of increased tumour-infiltrating lymphocytes; tumour or immune cell PD-L1 expression, both correlating with immune checkpoint inhibitor response in other tumour types; and non-synonymous mutations capable of eliciting a neoantigen-specific T-cell response. 4 In 2018, the IMpassion130 study 5 reported a 40% risk reduction in disease progression or death with first-line atezolizumab added to nab-paclitaxel, resulting in the approval of this anti-PD-L1 for advanced triple-negative breast cancer expressing PD-L1.
The Lancet Oncology , commentaire, 2019