Good, better, breast.
The Study: If you get wicked deja vu every time a checkpoint inhibitor trial gets published these days, you’re not alone. So when we saw this, we wondered: “Has there really not been a positive phase 3 trial in breast cancer yet?” Apparently not. IMpassion130 compared Abraxane +/- atezolizumab as first-line treatment for over 900 women with metastatic TNBC of any PD-L1 status. That last part has caught some serious flack on social media as a ploy to grab a larger market share, though, to be fair, PD-L1 expression hasn’t proved to be a solid surrogate for those who will and won’t benefit in other disease sites. Alas, the addition of atezo did prolong median progression-free survival from roughly 5 to 7 months, which was indeed driven by those who were PD-L1 positive. The interim overall survival analysis was negative, though there haven’t been enough events. Important to note is that the vast majority of patients ultimately progressed, and about 25% of those went on to get capecitabine, another up-and-comer in TNBC.
Bottom Line: IMpassion130 has a good shot at leading to the first FDA approval for a checkpoint inhibitor as an upfront treatment option for breast cancer, in this case metastatic TNBC. | Schmid, N Engl J Med 2018