Yasuaki Sagara, Chief of Breast Oncology at Sagara Hospital, Social Medical Cooperation, shared a post on X:
“Overview: Personalized Treatment for Stage II–III TNBC, ASCO Educational Book 2026
While pembro combination therapy was standardized in KEYNOTE-522, approximately 20% relapse within 5 years. We have entered a phase where decisions on “who should undergo escalation/de-escalation” are guided by ADC, anti-VEGF, dual ICI, and biomarkers (TIL/ctDNA/gut microbiota).
Key Points:
- KEYNOTE-522 Final: 5-year EFS 81.2% vs 72.2%, 5-year OS 86.6% vs 81.7% (pCR 64.8% vs 51.2%)
- irAE 35% (grade≥3 13.1%), many endocrine irAEs are irreversible
- I-SPY2.2 Dato-DXd+durva: overall pCR 50%, HER2−/immune+ subgroup 54%
- NeoSACI-IO (salvage with SG+pembro for intermediate non-responders): pCR 48% vs historical control 20%
- PLANeT low-dose pembro 50mg q6w: pCR +13.3% (equivalent additive benefit to standard dose)
- Ongoing Phase III: SCARLET / TROPION-Breast04 / ASCENT-05/OptimICE-RD etc.
From ‘KEYNOTE-522 for all cases’ to ‘stratified adjuvant therapy based on pCR, ctDNA, TIL.’ In cases with residual disease, results from SG+pembro and Dato-DXd+durva could determine the next standard.”
Title: Personalizing Curative Therapy in Stage II to III Triple-Negative Breast Cancer
Authors: Alexis LeVee, Maeve A. Hennessy, Dame Idossa, Roberto A. Leon-Ferre, Rita Nanda, Heather McArthur
Read the Full Article.
