1. KN 522 Early TNBC : 8% EFS benefit and 8% Distant met free survival benefit over 3 yr. OS data are not statistically significant at 3 yr with the addition of Keytruda to carbo taxol- AC. My personal comment on this is that I would not use the 3 week AC dose as in this trial just to accommodate keytruda regimen. We know that DDAC is better in high-risk patients. Unanswered questions include: whether should Keytruda be continued if path CR is achieved. What if path CR is not achieved in BRCA + patients? PARP or Capecitabine +/- keytruda?
2. Monarch- E High risk node positive ER+- Ki 67 prognostic but not predictive of abema benefit. Inclusion criteria N2 disease. If N1 disease, had to have either T3, G3, or ki67 20% or higher disease. absolute improvements in 3-year IDFS and distant relapse-free survival rates of 5.4% and 4.2%, respectively, for the ITT population
3. Brightness trial TNBC: This was an interesting trial presented at ESMO 2021. The key questions were to determine if adding carboplatin and/or veliparib to standard AC-T improved outcomes. Veliparib made no difference even in BRCA germline mutated patients. Carboplatin improved EFS and path CR in all comers.
4. Olympia BRCA 1/2 : 1 yr adjuvant olaparib for high risk HER 2 neg patients BRCA 1/2.
TNBC 80% or ER+ 18%. 50 % received neoadjuvant. 7% DDFS benefit in 3 yr. 9% IDFS benefit.
OS data 3 yr OS improvement 3.8%
CPS EG 3 or higher indicates high risk of relapse in ER+ patients.
Calculator:
http://www3.mdanderson.org/app/medcalc/index.cfm?pagename=bcnt
5. Rx PONDER
Recurrence score 0-25 Post menopausal women with 1-3 LN, no chemo benefit
Premenopausal women: 5% benefit in IDFS and 2.5 % benefit in distant recurrence free survival.
Benefit was seen in pre-menopausal women with micro mets and macro mets.
6. TEXT and SOFT trials:
OFS: 13 yr follow up 3.3% OS benefit with exemestane with OFS compared to tamoxifen with OFS
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