DR RUGO: So there are a number of triple-negative trials looking at patients receiving chemotherapy with a checkpoint inhibitor versus the chemotherapy alone. There are combinations. For example, there’s a trial looking at a CDK4/6 inhibitor combined with a checkpoint inhibitor in hormone receptor-positive disease. We don’t know what that will show yet. There are combinations of different targeted agents. And, of course, in HER2-positive disease where we know there’s these TILs that are infiltrating the tumor — and that correlates with outcome to some degree — there’s a lot of interest in studying checkpoint inhibitors there too, as well as some pilot studies going on.
So there’s actually a huge effort going on now. There’s the neoadjuvant I-SPY trial that I mentioned with pembrolizumab. And there is a postneoadjuvant cooperative group trial planned to open in the not-too-distant future. That will look at pembrolizumab in patients who have residual triple-negative breast cancer after neoadjuvant therapy but will likely allow capecitabine based on the CREATE-X data. And I think that there are other agents being tested in those settings as well.
People are interested in trying to look at combinations of immune agonists with checkpoint inhibitors. So you give the first drug to stimulate the immune response, and then you give the checkpoint inhibitor to unleash the tumor onto the stimulated immune response. And that’s going to be fascinating to make sure that we don’t cause overt immune activation, that we don’t increase toxicity and that we actually can see an improvement in outcome.
T, AC