Breakthrough in TNBC Treatment: Avelumab Extends Overall Survival

The A-BRAVE trial (NCT02926196) investigated the effectiveness of avelumab (Bavencio), an immunotherapy drug, as a treatment for early-stage triple-negative breast cancer (TNBC) patients at high risk of relapse. TNBC is an aggressive form of breast cancer with limited treatment options.

The study randomly assigned patients to receive either avelumab or a placebo for 1 year after standard treatment. Patients were considered high risk based on factors like tumor size, lymph node involvement, and response to initial chemotherapy.

While avelumab did not improve disease-free survival, it significantly extended overall survival for these patients. This suggests that immunotherapy may have a role in improving outcomes for patients with high-risk TNBC. Further analysis of the data is ongoing to explore potential benefits in specific patient groups.

Here, Pierfranco Conte, MD, scientific director of the San Camillo IRCCS Hospital in Venice Lido, Italy, discussed the implications of these findings.

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0:05 | Now pembrolizumab is the standard of care for high-risk triple-negative breast cancer patients. Most triple-negative breast cancer patients are treated upfront with chemotherapy plus pembrolizumab and continue pembrolizumab after surgery irrespective of response obtained with new adjuvant treatment, even if they get a pathologic complete response. As a matter of fact, we know that the difference in terms of obtaining a PCR is not so great by adding pembrolizumab, only about 7.5%. And again, we know that those patients who achieved pathologic complete response have a very good prognosis, irrespective of effect if they receive pembrolizumab or not.

0:46 | My clinical viewpoint is that avelumab might have a role in 2 situations First, patients with a lower tumor burden for which physicians decide to start with neoadjuvant chemotherapy without pembrolizumab because of the tumor burden is lower, the smaller the size, clinically negative lymph nodes. But at the end, some of his patients still have invasive residual disease at the time of surgery. And these patients, now we know we can improve prognosis by using avelumab. Another might be those patients who, in spite of having larger size tumors, more clinically positive lymph nodes, for some reason, clinicians are uncertain if to use or not [pembrolizumab]. Maybe prior immune-related disease performance status and so on. So we start with chemotherapy alone, they do not achieve a pathologic complete response. Again, in that case, the option for single-agent avelumab is a good option because another important point is that the tolerability was very good.