Treatment Options Available
- Early stage disease means that the cancer has not spread beyond the breast or the lymph nodes under your arm
- Hormonal therapy and therapies targeted to HER2 are not options for triple-negative breast cancer
- In addition to surgery and radiation, chemotherapy is a mainstay of treatment for early stage triple-negative breast cancer
- Different chemotherapy combinations may be used
“If you have early stage disease, that means that the cancer has not spread beyond your breast or potentially beyond the lymph nodes in your armpit,” says Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York.
Combination Therapy Is Common
Read MoreImmunotherapy Recently Approved
In 2021, the FDA approved the immunotherapy drug pembrolizumab for the treatment of early-stage triple-negative breast cancer (TNBC). Pembrolizumab (Keytruda) is already used to treat other cancers, including melanoma and non-small cell lung cancer. Doctors heralded the FDA’s approval of pembrolizumab as a potentially paradigm-shifting advancement in breast cancer treatment.
For patients with stage 2 or 3 TNBC, adding the immune-boosting medication pembrolizumab to combination chemotherapy before surgery, increases chances of living free of breast cancer, explains oncologist Dr. Sylvia Adams, director of the Breast Cancer Center at NYU Langone’s Perlmutter Cancer Center. She was one of several researchers involved with the pembrolizumab trials. “It changes the standard of care and should be discussed with all patients who are diagnosed with stage 2-3 TNBC,” she adds. “Yes, it’s a game-changer, though there is much more to be learned.”
In the phase III trial that preceded the FDA’s approval, a regimen of pembrolizumab with neoadjuvant (before surgery) platinum-based chemotherapy and then pembrolizumab alone extended event-free survival in patients with early-stage TNBC. The trial included 1,174, with 784 receiving 200 mg of pembrolizumab every three weeks in addition to neoadjuvant chemotherapy—four cycles of paclitaxel and carboplatin and then four cycles of doxorubicin or epirubicin plus cyclophosphamide. The other 390 study participants received chemotherapy plus placebo.
At the median follow-up of 39 months, pembrolizumab showed a significant event-free survival benefit compared with chemotherapy alone. All patients underwent surgery and received radiation therapy as indicated. Adjuvant treatment (after surgery) included up to nine cycles of pembrolizumab or placebo, depending on which randomized group the patient belonged. The number of cycles varied depending on factors such as disease recurrence or unacceptable toxicity. Pembrolizumab is an anti-PD-1 monoclonal antibody administered intravenously.
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