Tecentriq for miantenance in tripe negative brest cancer – pro

Tecentriq is FDA approved for beast cancer in combination with paclitaxel protein-bound for the treatment of adult patients with unresectable locally advanced or metastatic TNBC whose tumors express PD-L1 (PD-L1 stained tumor-infiltrating immune cells [IC] of any intensity covering ≥ 1% of the tumor area), as determined by an FDA approved test. This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial(s).
Unfortunately, there had not been any trials of Tecentriq maintenance strategies. FDA Approves KEYTRUDA® (pembrolizumab) for Treatment of Patients With High-Risk Early-Stage Triple-Negative Breast Cancer in Combination With Chemotherapy as Neoadjuvant Treatment, Then Continued as Single Agent as Adjuvant Treatment After Surgery.

Kaginara et al wrote about maintenance Tecentriq: ” While the observed prolongation of median PFS in the IMpassion130 trial may be considered modest, there is a subset of patients who receive long-term benefit with maintenance atezolizumab after discontinuation of nab-paclitaxel. For these exceptional responders, we consider this therapy to be a breakthrough by providing prolonged control of disease without traditional chemotherapy-related toxicity. ” With the current state of knowledge, it is E/I and not medically necessary.

Kagihara JA, Andress M, Diamond JR. Nab-paclitaxel and atezolizumab for the treatment of PD-L1-positive, metastatic triple-negative breast cancer: review and future directions. Expert Rev Precis Med Drug Dev. 2020;5(2):59-65.

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