Triple threat.

Pathologic response to neoadjuvant therapy for triple negative breast cancer is an important prognostic factor and is strongly associated with overall survival.  One strategy has been to improve outcomes for those who have partial responses by adapting adjuvant systemic therapy (i.e. capecitabine). But another approach is to increase the rate of pCR up-front. In IMpassion031, over 300 patients with stage II-III TNBC were randomized to neoadjuvant therapy consisting of standard nab-paclitaxel, doxorubicin, and cyclophosphamide with or without concurrent atezolizumab (an immune checkpoint inhibitor). Among all-comers, there was a significant increase in the pCR rate with the addition of atezolizumab (41→ 58%). Among patients with 1% or greater PD-L1 positivity, there was a 20% absolute increase in the pCR rate from 49→ 69%. TBL: Adding atezolizumab to neoadjuvant chemotherapy increases the rate of pathologic complete response for women with TNBC. | Mittendorf, Lancet 2020