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Immune-checkpoint inhibition for metastatic triple-negative breast cancer: safety first?

Nature Reviews Clinical Oncology volume 16, pages 399–400 (2019)Cite this article

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Breast oncologists are intimately familiar with managing treatment-related adverse events of endocrine, cytotoxic and targeted therapies, but the approval of immune-checkpoint inhibitors (ICIs) for metastatic triple-negative breast cancer (TNBC) poses new challenges. Herein, we discuss the safety of ICIs in metastatic TNBC, with an emphasis on immune-related adverse events.

In March 2019, the FDA granted accelerated approval to the front-line chemo-immunotherapy combination of the anti-programmed cell death 1 ligand 1 (PD-L1) antibody atezolizumab and nab-paclitaxel for PD-L1+ metastatic triple-negative breast cancer (TNBC), on the basis of findings from the phase III IMpassion130 trial1. Published trials have now evaluated immune-checkpoint inhibitors (ICIs) — including anti-programmed cell death 1 (PD-1) or anti-PD-L1 antibodies as monotherapy or combined with taxanes or anti-cytotoxic T lymphocyte antigen 4 (CTLA-4) antibodies in >1,000 patients with metastatic TNBC1,2,3,4,5,6,7,8. A consistent trend towards improved overall response rate has been noted with combination therapies (39–53%)1,2,8 compared with ICI monotherapy (5–24%)4,5,6,7 (Supplementary Table 1). The potential for long-term survival with ICIs makes this approach extremely appealing3,4,6,7, but recognition of the unique and sometimes life-changing nature of immune-related adverse events (irAEs) will be important for their safe use.

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Authors and Affiliations

  1. Oncology Hematology Division, NYU-Winthrop Hospital, Mineola, NY, USA

    Nina D’Abreo

  2. Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, USA

    Sylvia Adams

Authors
  1. Nina D’Abreo
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  2. Sylvia Adams
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Correspondence to Sylvia Adams.

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Competing interests

S.A. declares that she has received research funding to her institution from Merck, Genentech, Amgen, Celgene, Bristol-Myers Squibb (BMS) and Novartis and that she is a Steering committee member for IMpassion130 (uncompensated), a Global PI on Keynote-086 (uncompensated) and a consultant for BMS (uncompensated). N.D’A. declares no competing interests.

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D’Abreo, N., Adams, S. Immune-checkpoint inhibition for metastatic triple-negative breast cancer: safety first?. Nat Rev Clin Oncol 16, 399–400 (2019). https://doi.org/10.1038/s41571-019-0216-2

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