Obviously, the study has not clarified the role of platinum in patients with TNBC, who did not receive this drug during neoadjuvant or adjuvant therapy
Obviously, the study has not clarified the role of platinum in patients with TNBC, who did not receive this drug during neoadjuvant or adjuvant therapy. from metastatic lesions of these individuals. PD-L1 screening from archival material is already carried out on request, and results are available within 5-7 working days. The results of the IMpassion 130 study offered at ESMO 2018 in Munich and published on-line in the by Schmidt et al. were breathtaking and will change the standard of care in the first-line treatment of individuals with metastatic TNBC. Obviously, the study has not clarified the part of platinum in individuals with TNBC, who did not receive this drug during neoadjuvant or adjuvant therapy. Furthermore, results of the IMpassion 130 study were driven primarily, if not exclusively, from the individuals who experienced PD-L1-overexpressing tumors. After ESMO 2018 and San Antonio 2018, our pathologists should be prepared to do PD-L1 subtyping in the primary tumor and also in the immune cells of individuals with metastatic TNBC. Since olaparib and talazoparib have also demonstrated excellent results in individuals with BRCA-mutated metastatic TNBC, the friend diagnostic algorithm should be: BRCA screening as well as PD-L1 subtyping, and after this the decision should be discussed with the patient whether one should start with one of the Parp inhibitors olaparib or talazoparib in BRCA-mutated individuals, followed by atezolizumab, versus starting with atezolizumab in individuals who have a PD-L1 overexpression. At the time, I personally favor the second option since we have seen a definite survival benefit with atezolizumab in PD-L1 overexpressors. Probably the most demanding question is to combine these two medicines in individuals with metastatic TNBC. Query 2: Does the option of TDM-1 (trastuzumab-emtansine) after not reaching a pathologic total response (pCR) travel your decision to use neoadjuvant treatment for early HER2-positive breast cancer individuals? How MK-8617 does adjuvant pertuzumab impact on your decision? TDM-1 is the fresh standard of care. Yes, definitely, I find the KATHERINE data very convincing and I strongly believe that in the analyzed indication this will become standard of care. I do not observe any troubling data to show a decreased effectiveness in individuals who received a dual blockade as part of their neoadjuvant treatment. We do not have convincing data to combine TDM-1 and pertuzumab, however, so my choice will become TDM-1 in MK-8617 non-pCR instances. Neoadjuvant chemotherapy with trastuzumab + pertuzumab is definitely our standard for those individuals with HER2-positive main breast cancer. Therefore, these beneficial data of adjuvant TDM-1, as compared to adjuvant trastuzumab, do not influence the decision whether neoadjuvant therapy should be given or not. Up until now two adjuvant treatment regimens are proven to be superior to adjuvant trastuzumab only, i.e. adjuvant trastuzumab + pertuzumab in node-positive disease and TDM-1 in individuals without a pCR after neoadjuvant treatment. We can now further individualize the adjuvant treatment routine based on significant results from clinical tests. However, due to the current absence of data from randomized studies comparing these two newly founded MK-8617 adjuvant treatment methods with or without the inclusion of neoadjuvant/adjuvant pertuzumab, an ideal standard treatment routine for individuals with early HER2-positive breast cancer warrants further tests. The KATHERINE study is about to change the standard of care of individuals with HER2-overexpressing main breast cancer. For many years, the German AGO guideline has been favoring neoadjuvant chemotherapy and anti-HER2 treatment instead of surgery first followed by adjuvant chemotherapy with anti-HER2 therapy. St. Gallen offers adopted with their recommendation in KLF1 the year 2017, also favoring neoadjuvant therapy in these individuals. If we want to give our individuals with HER2-overexpressing tumors the best opportunity to survive we have just one option: start with neoadjuvant therapy including anti-HER2 treatment (either trastuzumab or the combination of trastuzumab and pertuzumab), followed by TDM-1 after surgery in those individuals who have MK-8617 residual disease in the breast or/and in the lymph nodes. The combination of trastuzumab and pertuzumab in the adjuvant therapy has shown no benefit in the APHINITY study in individuals with.