Metastatic TNBC

 Reference: https://ascopubs.org/doi/10.1200/EDBK-25-481154

1. Keynote 355 showed addition of pembro to advanced TNBC with CPS 10 or higher resulted in better OS: In the CPS-10 subgroup, the median overall survival was 23.0 months in the pembrolizumab–chemotherapy group and 16.1 months in the placebo–chemotherapy group. 40% of patients are eligible for pembro upfront. 

2. ASCENT trial: single agent saci versus chemo. Overall survival (12.1 v 6.7 months; HR, 0.48 [95% CI, 0.38 to 0.59]) with sacituzumab govitecan therapy.

3.  DESTINY breast 04- T-DXd improved both PFS and overall survival and led to an objective response rate of 50%.

4. PARP inhibitors for GBRCA 1 or BRCA 2 front line. OlympiaD

In first-line, median OS was numerically longer for olaparib versus TPC (22.6 versus 14.7 months, respectively).  

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In first-line, the 3-year OS rate was 40.8% for olaparib versus 12.8% for TPC.   

EMBRACA trial talazoparib 8.6 m versus 5.6 m PFS

However in 2025 the following protocol has changed.

Front line treatment: new standard of care

• BRCA1 or BRCA 2--> if yes olaparib or talazoparib
• If BRCA neg, check PDL1 CPS > 10--> sacituzumab+ pembro ( ASCENT 04, PFS HR 0.65,Duration of response 16 months)
• If BRCA neg, PDL 1 neg---> Sacituzumab single agent (ASCENT 03, PFS 9 month)