Importance of Sequencing Immunotherapy in Breast Cancer

Elizabeth A. Mittendorf, MD, PhD, the Rob and Karen Hale Distinguished Chair in Surgical Oncology and director of surgical research and the Breast Immuno-Oncology Program at the Dana-Farber/Brigham Women's Cancer Center, discusses different data looking at sequencing therapies and why it is important in the breast cancer setting.

Mittendorf says the sequencing of drugs for patients with breast cancer is critically important. She highlights preclinical data from the Child’s Cancer Center in Portland, Oregon, which looks at the differences of sequencing or giving therapy concomitantly when using an OX40 and PD-L1 combination. The sequence also matters in this situation because 1 way of sequencing works and the other way doesn’t.

The thoughts that physicians have in clinical practice are also needed in this sequencing space. She thought the data showing patients with breast cancer achieving or experiencing better pathologic complete response when receiving durvalumab (Imfinzi) before chemotherapy was interesting. It was presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting by the German Breast Group and subsequently published in 2019.

Mittendorf feels that the oncologists in this setting are aware that questions about sequencing therapies for this patient population need to be answered. It is going to take laboratory-based work, animal models, and observations from appropriately designed clinical trials.

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