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Aug 9, 2020 06:13AM
Something for your list- this was a phase 2 trial of an immunotherapy combination for TNBC, heavily treated patients- it was not remarkable except for a terrific response from those patients who were ER-positive but converted later on to ER-negative. Both Barbara Bigelow and Judy Perkins, who are presumed cured from immunotherapy trials (one a CAR-T the other an immuno-chemo combo) were in this category of patients whose cancers switched subtypes. Bigelow said her Dana-Farber MO said the best responses they get in immunotherapy are those with that particular switch.
Here are the conclusions and a link to the trial summary is provided below.
This trial combined Pembrolizumab with another immunotherapy (Imprime IGG). "Researchers observed a particularly pronounced clinical benefit in a subgroup of patients who initially were diagnosed with ER-positive/PR-positive disease but progressed on endocrine therapy and — prior to treatment in this study — had biopsies that confirmed conversion to triple-negative breast cancer."
For Keytruda as monotherapy, the response of all TNBC patients was:
...a 5.3% overall response rate, a 7.6% disease control rate at 24 weeks, median PFS of 2 months, and median OS of 9 months.
Adding the Imprime IGG lead to an ORR of 15.9% (95% CI, 7.9-29.4). More than one-third (38.6%; 95% CI, 25.7-53.4) of patients achieved stable disease and 40.9% (95% CI, 27.7-55.6) had progressive disease.
But a subgroup of 12 patients originally diagnosed with ER-positive/PR-positive disease who underwent prior treatment with endocrine therapy and later converted to triple-negative disease did much better.
These patients had all received prior treatment with tamoxifen, aromatase inhibitors or CDK 4/6 inhibitors, and all had received at least one line of chemotherapy after development of metastatic disease.
In this group, six (50%) achieved response to the combination, four (33%) achieved stable disease and six (50%) achieved disease control for 6 months. Median OS in this group was 17.1 months.
The upshot is that everyone who has a ER-positive to ER-negative conversion should seek out some kind of immunotherapy combo
10/2003, IDC, Stage IIB, ER+/PR+, HER2-
7/2015, Stage IV, metastasized to bone, ER+/PR-, HER2-