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Medicine Matters oncology

I think, from my point of view, the key take home messages from IMpassion031 are that atezolizumab plus chemo improves PCR in early triple negative breast cancer in a clinically and statistically significant and meaningful way with a 16.5% increase. And this, to me as a clinician, means that immunotherapy has arrived in early triple negative breast cancer, and that we will be treating our patients in the future, also incorporating immunotherapy into the management of early triple negative breast cancer.



I think the results of IMpassion031 very concordant with the results we've seen from KEYNOTE-522, which is the other neoadjuvant immunotherapy trial in early breast cancer. We do see clinically meaningful improvement of PCR independent of the backbone of chemotherapy used. The KEYNOTE study used carbo, but paclitaxel as the taxane. And the IMpassion031 used nabpaclitaxel, but no carbo.



But qualitatively, the results are very similar. And the other similar finding between both studies is that apparently in the early breast cancer setting, at least the new adjuvant setting, the PDL1 status that does not predict the efficacy of immunotherapy with regard to PCR. This is something we have to follow up. There is a number of reasons why this could be the case. Maybe chemotherapy by itself also induces immunogenicity in the tumor. So there will be an upregulation of PDL1 under therapy, and that's why the initial PDL1 status is not predictive. But that's just speculation.



The next steps, having seen now the results of IMpassion031, is first of all, we need to further collect the data from the follow up. So we know whether the PCR advantage translates into a survival advantage for our patients. And we also have to look carefully what patients got after surgery because that was up to the investigator. And second, obviously as clinicians we hope that this will be taken further to a registrational pathway. So we do have the chance to treat our patients with atezolizumab in the early breast cancer setting.