Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer

Publication Date: April 13, 2022
Last Updated: September 2, 2022


New Recommendation from 2022 Guideline Rapid Recommendation Update

For patients with T1cN1-2 or T2-4N0 (stage II or III), early-stage triple negative breast cancer, the Panel recommends use of pembrolizumab (200 mg every 3 weeks or 400 mg every 6 weeks) in combination with neoadjuvant chemotherapy, followed by adjuvant pembrolizumab after surgery. Adjuvant pembrolizumab may be given either concurrent with or after completion of radiation therapy. Given that immune-related adverse events (irAEs) associated with pembrolizumab therapy can be severe and permanent, careful screening for and management of common toxicities are required. The ASCO guideline for management of irAEs in patients treated with immune checkpoint inhibitor therapy offers detailed practice recommendations and should be consulted by clinicians who prescribe pembrolizumab for patients with early-stage TNBC, ( EB , I , B , M )
Qualifying Statements: Results from KEYNOTE-522 are based on continued pembrolizumab in the adjuvant setting. There is uncertainty concerning the optimal adjuvant treatment given independent benefits of capecitabine in TNBC and olaparib in patients with germline BRCA mutations without pembrolizumab. There are no data to support the use of pembrolizumab in combination with either capecitabine or olaparib.

Measuring Response

Patients receiving neoadjuvant therapy should be monitored for response with clinical examination at regular intervals. Breast imaging may be used to confirm clinical suspicion of progression and for surgical planning. When imaging is used, the modality that was most informative at baseline — mammography, ultrasound, or magnetic resonance imaging — should be used at follow up. ( IC , Ins , , M )



Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer

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