Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of breast cancer

Abstract

Breast cancer has historically been a disease for which immunotherapy was largely unavailable. Recently, the use of immune checkpoint inhibitors (ICIs) in combination with chemotherapy for the treatment of advanced/metastatic triple-negative breast cancer (TNBC) has demonstrated efficacy, including longer progression-free survival and increased overall survival in subsets of patients. Based on clinical benefit in randomized trials, ICIs in combination with chemotherapy for the treatment of some patients with advanced/metastatic TNBC have been approved by the United States (US) Food and Drug Administration (FDA), expanding options for patients. Ongoing questions remain, however, about the optimal chemotherapy backbone for immunotherapy, appropriate biomarker-based selection of patients for treatment, the optimal strategy for immunotherapy treatment in earlier stage disease, and potential use in histological subtypes other than TNBC. To provide guidance to the oncology community on these and other important concerns, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew upon the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for breast cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence-based and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with breast cancer.

Pembrolizumab Plus Gemcitabine in the Subset of Triple-Negative Advanced Breast Cancer Patients in the GEICAM/2015-04 (PANGEA-Breast) Study

“…Moreover, translational data that could definitively establish reliable biomarkers are certainly needed, as patients benefiting from immunotherapy should be better characterized. Lately, to summarize the current knowledge regarding immunotherapy in BC, the Society for Immunotherapy of Cancer (SITC) has published a practice guideline that revises the available data and makes some proposals and recommendations [4].…”

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“…The Food and Drugs Administration (FDA) has approved combined chemotherapy and immunotherapy treatment with both anti PD-L1 (such as atezolizumab) and anti PD-1 (such as pembrolizumab) monoclonal antibodies for PD-L1+ TNBC ( 188 ). New indications for the use of these combination therapies are also expanding to other patient populations, such as advanced hormone receptor-positive (HR+) BC or HER-2 positive patients who are refractory to standard therapy ( 187 ).…”

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“…When combined with an acceptable safety profile, immune checkpoint inhibitors are a promising new therapeutic option in TNBC. Recently, the Society for Immunotherapy of Cancer (SITC) published a clinical practice guideline on immunotherapy for breast cancer [ 85 ]. Recommendations in this clinical practice guideline include diagnostic testing, treatment planning, immune-related adverse events, and patient quality of life considerations to provide guidance to the oncology community treating breast cancer patients with immunotherapies.…”