The Michelangelo Foundation’s research is having a leading role at the San Antonio Breast Cancer Symposium 2021, where 4 works have just been presented with data focusing mostly on the NeoTRIP trial, designed and coordinated by Foundation’s researchers: in two poster sessions, new translational data help to clarify some key aspects of triple-negative breast cancer.
NeoTRIP is a phase III clinical trial to evaluate the clinical benefits of adding a neoadjuvant immunotherapy with atezolizumab to chemotherapy with nab-paclitaxel and carboplatin in patients with high risk or locally advanced triple-negative breast cancer. One of the new studies on patient data addresses the issue of optimizing immune checkpoint inhibitors treatment through the identification of predictive biomarkers: results show that the 27-gene IO score can be used for this purpose, because it’s strongly predictive of a pathological complete response in IO score positive patients treated with atezolizumab. Another paper confirms that the dynamics of the IO score in the early stages of therapy is associated with a higher rate of pathological complete response, independently of baseline biomarkers, and can therefore be an early surrogate of the treatment benefit.
Another analysis also indicates that the evaluation of PD-L1 as a predictive biomarker depends very much on the time of assessment and treatment received: the dynamic analysis of its expression indicates that there are significant and treatment-specific changes in the immune environment and this observation may explain why baseline PD-L1 but not on-treatment PD-L1 was predictive of response to atezolizumab in the NeoTRIP trial. The fourth Michelangelo Foundation’s paper presented at the US meeting aimed to understand the different immunomodulatory effects of different regimens of chemotherapy associated with immune checkpoint inhibitors; in addition to the data from NeoTRIP trial, researchers used also public data from another cohort of patients treated with neoadjuvant doxorubicin and cyclophosphamide. Both chemotherapies, according to results, have a strong and early immunomodulatory effect; anthracyclines elicit a quantitatively stronger immune modulatory effect, especially in ‘immune low’ tumors. These observations may therefore have clinical implications for the selection of the ideal chemotherapy added to immune checkpoint inhibitors in PD-L1 negative/not-inflamed tumors.