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Real-World Outcomes with the KEYNOTE-522 Regimen in Early-Stage Triple-Negative Breast Cancer.

Casey Connors1, Stephanie A Valente1, Ayat ElSherif1,2

  • 1Department of Breast Surgery, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.

Annals of Surgical Oncology
|October 22, 2024
PubMed
Summary

The KEYNOTE-522 regimen improved pathologic complete response (pCR) rates in early-stage triple-negative breast cancer (TNBC) patients, leading to fewer axillary node dissections (ALND). Breast conservation therapy (BCT) eligibility did not differ between groups.

Keywords:
Breast conservation therapyImmune-related adverse eventsImmunotherapyKEYNOTE-522Pathologic complete responsePembrolizumabTriple-negative breast cancer

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Area of Science:

  • Oncology
  • Medical Research
  • Clinical Trials

Background:

  • Triple-negative breast cancer (TNBC) presents unique treatment challenges.
  • Neoadjuvant chemotherapy (NAT) is a standard approach for early-stage TNBC.
  • Evaluating novel NAT regimens like KEYNOTE-522 is crucial for improving outcomes.

Purpose of the Study:

  • To assess the efficacy of the neoadjuvant (NAT) KEYNOTE-522 regimen compared to control NAT.
  • To determine if KEYNOTE-522 NAT increases pathologic complete response (pCR) rates.
  • To evaluate the impact of KEYNOTE-522 NAT on breast conservation therapy (BCT) and axillary node dissection (ALND) rates.

Main Methods:

  • Retrospective analysis of Stage II-III TNBC patients (2019-2022) who received NAT.
  • Comparison of KEYNOTE-522 NAT versus control NAT for pCR, BCT, ALND, and survival.
  • Documentation of immune-related adverse events (irAEs) associated with chemoimmunotherapy.

Main Results:

  • KEYNOTE-522 NAT showed a significantly higher pCR rate (59.3%) versus control (33.1%; p=0.001).
  • No significant difference in BCT rates was observed between KEYNOTE-522 (32.1%) and control (33.1%) groups (p=0.47).
  • KEYNOTE-522 NAT was associated with significantly lower ALND rates (25.6%) compared to control (39.6%; p=0.03).
  • BRCA1-positive patients demonstrated high pCR rates irrespective of treatment group.

Conclusions:

  • Real-world data support KEYNOTE-522 NAT for early-stage TNBC due to higher pCR and reduced ALND rates.
  • While most patients in both groups became eligible for BCT, the rates did not differ significantly.
  • KEYNOTE-522 NAT represents a valuable option for improving treatment response in TNBC.