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How do you decide between 1st line PARPi or immunotherapy in a patient with metastatic gBRCA mutated TNBC?
Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of surgery.
Are there scenarios where you would consider combining therapy?
Answer from: Medical Oncologist at Academic Institution
In a patient with a gBRCAm that is PDL1+, I generally consider chemotherapy + checkpoint inhibition in the first line setting given the known survival benefit upfront, and since it is unknown if this benefit with chemotherapy + immunotherapy would be seen in the later line setting. We do have data t...
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Answer from: Medical Oncologist at Academic Institution
We updated the NCCN breast guidelines with a new section for metastatic TNBC. The guidelines place a preference to do pembrolizumab in a CPS>=10 patient first regardless of their BRCA status. If I knew they were BRCA1 mutated and CPS over 9, I would probably prioritize using carbo/gem plus pembro...
Answer from: Medical Oncologist at Academic Institution
I would have treated a patient with gBRCA+ TNBC with a regimen that includes a platinum agent in the neoadjuvant setting. With current FDA approval for olaparib in the adjuvant setting, this is a patient who now could have been treated with neoadjuvant ddAC/T followed by adjuvant olaparib ...
Answer from: Medical Oncologist at Community Practice
I tend to consider immunotherapy first if PD-L1 CPS>=10, unless toxicity is a major issue in a particular patient. In that case, PARPi would be my first choice.