Giuseppe Curigliano, MD, PhD
“IMPASSION130 IS a positive study of immuno-oncology that brings breast cancer into the immunotherapy era,” said the invited discussant of the trial, Giuseppe Curigliano, MD, PhD, Associate Professor of Oncology at the University of Milan and Chair of Early Drug Development at the Institute of European Oncology in Milan, Italy. “We have a new standard of care in programmed cell death ligand 1 (PD-L1)–positive triple-negative breast cancer.”
Chemotherapy—which can induce CD8 expression and reduce T-regulatory cells— clearly enhanced the benefit of the PD-L1 antibody (which has little single-agent activity), but whether nanoparticle albumin-bound (nab)-paclitaxel (Abraxane) was the best partner is an open question, said Dr. Curigliano. “I believe there are some chemotherapeutic agents that are even more immunogenic than nab-paclitaxel,” he explained, citing gemcitabine, cisplatin, doxorubicin, low-dose cyclophosphamide, paclitaxel, and oxaliplatin. “There are many trials ongoing, and new trials will be designed to evaluate which will be the best partner for immunotherapy.”
There are also studies underway in subsets within the triple-negative subtype of breast cancer. As a very heterogeneous entity, he noted, triple-negative disease cannot be tackled via one immune approach but will be stratified according to more than PD-L1. He named tumor mutational burden, immune activation gene signatures, and level of tumor-infiltrating lymphocytes as immune components that can be measured and should factor into treatment decision-making.
He further predicted that immune approaches will prove valuable outside of the triple-negative population. Trials testing some of these approaches are planned or underway.
Dr. Curigliano mentioned the important trials testing agents in the neoadjuvant setting, with correlative biomarker studies. These approaches would be the best ways, he said, of identifying the population of patients most likely to benefit from an immunotherapeutic approach. ■
DISCLOSURE: Dr. Curigliano has served on speakers bureaus for Novartis, Roche, and Pfizer.
IMMUNOTHERAPY APPEARS to be the new upfront standard of care for patients with metastatic triple-negative breast cancer, based on a late-breaking presentation at the European Society for Medical Oncology (ESMO) 2018 Congress1 and simultaneously published in The New England Journal of Medicine.2