Hope Rugo, MD, provides insights on best practices for managing metastatic TNBC in community settings.
Hope Rugo, MD: The real clinical pearls we need in this situation is to be sure to measure for PD-L1–positivity. Think about checkpoint inhibitors in the metastatic setting. Carefully choose the chemotherapy based on the patient’s own history of response to chemotherapy agents. Use nab-paclitaxel preferentially rather than paclitaxel if you’re using a taxane. Monitor carefully for immune toxicity. Treat early and educate our patients about these toxicities, because you can get almost any patient through toxicity if you recognize it early and treat early. It’s clear that if you don’t, the toxicities can become life-threatening. With the use of checkpoint inhibitors, we’ve seen real improvements in our patients with triple-negative breast cancer.
The future is trying to move these treatments earlier. There are exciting data from the early-stage setting we talked about, but also looking at new ways to give checkpoint inhibitors in the metastatic setting. Giving induction with checkpoint inhibitors or chemotherapy to try to jump-start the immune response. Using different targeted agents with immune checkpoint inhibitors, antibody-drug conjugates, or radiation therapy are all areas that are being tested. I mentioned PARP inhibitors earlier. It’s certainly an exciting time, when we have immune therapies that are effective in our patients with triple-negative breast cancer. But this only affects about 40% of patients in the metastatic setting who are at least a year from their recurrence, and about 38% of patients who are 6 months or farther out. We need better solutions for our patients with the most highly resistant disease and for those patients with PD-L1–negative disease.
Thank you for your attention.
Transcript edited for clarity.