Immunotherapy improves responses without reducing quality of life in early breast cancer


Adding an immune checkpoint inhibitor to the standard chemotherapy regimen for patients with early-stage breast cancer does not place a greater burden on patients’ ability to perform daily activities than chemotherapy alone, new research from researchers has shown by Dana-Farber / Brigham and Women’s, presented at the San Antonio Breast Cancer Symposium virtual session in the United States.

The report, along with previous findings that combining checkpoint inhibitors with chemotherapy can increase response rates in patients with early-stage triple-negative breast cancer, offers assurances that the benefits of the combination can be achieved without decrease the quality of life of patients, say the authors.

The study, presented by Elizabeth Mittendorf, director of the breast immuno-oncology program at the Dana-Farber / Brigham and Women’s Cancer Center, is the first to use patients’ own feedback to measure the impact of combination therapy on the daily functioning of patients with early stage breast cancer.

The analysis is based on data from the IMpassion031 study, a phase III trial of the safety and efficacy of the checkpoint inhibitor atezolizumab in conjunction with standard chemotherapy before surgery in 333 people with previously untreated triple-negative breast cancer. Atezolizumab works by blocking the PD-L1 protein in tumor cells, leaving the cells open to attack by the immune system.

Triple-negative breast cancer, which accounts for about 13% of breast cancer cases, is so named because it tests negative for estrogen and progesterone receptors and for the HER2 protein.

Triple negative cancers tend to grow faster than other forms of breast cancer and often have a worse prognosis. Trials of immunotherapy agents in disease seek to increase the treatment options available to patients.

Patients who participated in the IMpassion031 trial were randomly assigned to receive atezolizumab and the chemotherapy agents nab-paclitaxel, adriamycin, and cyclophosphamide, or the same chemotherapy agents plus a placebo, before undergoing breast cancer surgery. Their response to treatment was assessed at the time of surgery.

Researchers reported earlier this year that combination therapy increased the likelihood that patients with early-stage triple-negative breast cancer would have a complete response – a reduction in their cancer to undetectable levels.

This new study explored whether that improvement was accompanied by a decrease in patients’ performance of daily tasks. Trial participants were asked to rate their ability to perform everyday activities such as going to work and preparing meals in the months after treatment.

While participants reported greater difficulty in these areas, as a result of treatment side effects such as nausea, diarrhea, and fatigue, there was no difference between patients who received the combination therapy and those who received chemotherapy alone. As side effects subsided over time, patients in both groups recovered equally well.

“Treatment for early stage breast cancer is intended to be curative,” Mittendorf says. “In such cases, we want to be sure that improvements in outcomes are balanced by effects on patients’ quality of life. Our findings suggest that the combination of checkpoint inhibitors and chemotherapy meets that test. “

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