Matteo Lambertini, MD, PhD
Invited discussant of these two trials, Matteo Lambertini, MD, PhD, Associate Professor at the University of Genova–IRCCS Policlinico San Martino Hospital Genoa, Italy, emphasized the importance of longer follow-up periods for both these clinical trials and the need to wait for the additional ongoing studies that are investigating the role of atezolizumab in patients with early-stage triple-negative or HER2-positive breast cancer. Dr. Lambertini also noted the lack of biomarker research in both triple-negative and HER2-positive breast cancer trials, which could provide more information to guide treatment decisions.
Regarding the optimal chemotherapy backbone in combination with immune checkpoint inhibitors, Dr. Lambertini raised the question of whether dose-dense schedules, anthracycline-based chemotherapy, and platinum agents are necessary for all patients. He also stressed the need for improved postneoadjuvant treatment, particularly in patients without a pathologic complete response.
In the context of HER2-positive early-stage breast cancer, Dr. Lambertini questioned the role of immunotherapy and the optimal chemotherapy backbone when using dual anti-HER2 blockade. He also highlighted the potential cardiotoxicity issues when combining an anthracycline with dual anti-HER2 blockade and immune checkpoint inhibitors.
Given these toxicities, Dr. Lambertini expressed reservations about labeling the addition of immune checkpoint inhibitors to this regimen a “de-escalation” strategy. “I’m not sure this approach should be considered de-escalation, when other strategies in the context of optimal anti-HER2 therapy, such as single-agent taxane, not giving additional chemotherapy for patients with pathologic complete response, using antibody-drug conjugates alone, and potentially omitting chemotherapy for patients with early treatment responses, are being explored,” he concluded.
DISCLOSURE: Dr. Lambertini reported financial relationships with Roche, Novartis, AstraZeneca, Eli Lilly, Exact Sciences, Pfizer, MSD, Seagen, Gilead Sciences, Takeda, Sandoz, Ipsen, Libbs, Knight, and Daiichi Sankyo.
