Physician perspectives on the decision-making process for patients with high-risk early-stage triple-negative breast cancer in a community oncology setting

Pembrolizumab, FDA-approved in July 2021, administered in combination with chemotherapy is the standard neoadjuvant treatment for high-risk, early-stage, triple-negative breast cancer (esTNBC) due to its efficacy in the KEYNOTE-522 trial. Identifying factors influencing clinical adoption is key to optimizing patient outcomes. This study explored physicians' perspectives on pembrolizumab use in the neoadjuvant and adjuvant settings, focusing on the treatment decision-making process for esTNBC.

Eight US Oncology Network physicians (6 medical oncologists, 2 breast surgeons) participated in a survey and virtual focus group. Survey responses were analyzed descriptively, and focus group discussion transcripts underwent inductive thematic analysis.

Four themes emerged: widespread adoption of pembrolizumab as standard of care in esTNBC, rare nonuse due to contraindications, continued adjuvant use, and management of estrogen receptor (ER)-low/HER2- breast cancer similar to TNBC.

The study highlights broad integration of pembrolizumab for esTNBC patients due to survival benefits and manageable safety profile. Nonuse was limited to contraindications, patient preferences, or due to surgery referrals without medical oncology input. To optimize patient outcomes, future efforts should focus on physician-patient communication, multidisciplinary care coordination, and surgeon education regarding neoadjuvant guidelines. Further guidance for optimal adjuvant treatment of patients without pathological complete response is necessary.