When do you consider the addition of concurrent pembrolizumab to breast irradiation?  

With the publication of KEYNOTE-522 (Schmid et al., PMID 32101663), we are seeing this scenario much more frequently as patients continue the pembrolizumab in the adjuvant setting.A post-hoc analysis of the timing of radiation in the KEYNOTE-522 trial was presented in abstract form at SABCS 2022, (P...

While these are important issues to consider, in clinical practice I think it's not something that can realistically make much difference. The average half-life of pembrolizumab is 27 days, with a steady state achieved by 19 weeks (Longoria and Tewari, PMID 27485741). Most patients are receiving fix...

Based on the results of the KEYNOTE-522 study, in which during the adjuvant phase of the trial, any indicated RT was delivered concurrently with the adjuvant pembrolizumab cycles, I would consider the addition of pembrolizumab in this case, especially if the patient received neoadjuvant systemic che...

There are very few data yet on how best to combine immunotherapy and RT for patients with breast cancer, and even less for patients treated for local-regional disease. Verma and colleagues have just published a comprehensive review of this topic (Verma et al., PMID 38195030). The Institut Curie grou...

Based on KEYNOTE data, we do this concurrently routinely. Also, this is a review and recommendation from the ESTRO group Meattini et al., PMID 38301705 

We did a review of the available evidence (Verma et al., PMID 38195030), and we cannot make definitive conclusions. Drilling down on the post hoc exploratory subgroup analysis from KEYNOTE 522, concerning grade 3-5 treatment-related events were technically lower for concurrent vs 2 weeks post-RT (6....