Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_119_библиотеки_им_акад_М_И_Перельмана

Until recently, the mainstay of systemic therapy for TNBC was cytotoxic chemo­therapy, often including a combination of an anthracycline (such as doxorubicin or epirubicin, among others) paired with cyclophosphamide and followed by (or pre­ceded by) a taxane (such as paclitaxel or docetaxel). Several studies tested whether incorporating additional agents could improve the rates of pCR and long-term out­comes. The incorporation of immunotherapy agents (particularly pembrolizumab) to neoadjuvant chemotherapy has been one of the major advances of the manage­ment of early-stage TNBC, leading to improvements both on pCR rates and event­free survival (the time between treatment and the occurrence of a new “event” such as recurrence, a new primary cancer or death). The KEYNOTE-522 clinical trial evaluated the addition of pembrolizumab to a chemotherapy backbone consisting of carboplatin + paclitaxel followed by an anthracycline and cyclophosphamide (Schmid etal., 2020). In this trial, 1174 patients with newly diagnosed stage 2 or 3 TNBC were randomly assigned (in a 2:1 fashion) to receive IV pembrolizumab plus chemotherapy (paclitaxel and carboplatin followed by doxorubicin and cyclophos­phamide) versus standard of care with chemotherapy plus placebo. Eligibility patients had newly diagnosed node-positive TNBC or tumors measuring ≥2 cm (regardless of nodal involvement). Patients with both PD-L1-positive and PD-L1­negative TNBC were eligible (although 84% in the treatment arm were PD-L1 posi­tive). Following surgery, patients received nine additional cycles of adjuvant pembrolizumab or placebo every three weeks regardless of treatment response.