Hello I’m 36 and have just been diagnosed with TNBC grade 3 stage 1. I’m being offered two pre surgery options.
chemotherapy every 3 weeks for 6 months doxetaxal and carboplatin
chemotherapy 3 weekly carboplatin + weekly paclitaxel + 3 weekly immunotherapy pembrolizumad for 12 weeks followed by a year of immunotherapy following surgery
Has anyone else faced this decision? Or undertaken any of these options with advice as to which to choose?
any views appreciated
I also replied on the Pembrolizumab thread. I have metastatic TNBC, spread to my liver. I am currently on a regime of Pembrolizumab plus NAB-Paclitaxel, I will have the combination for 6 months, and then continue with pembrolizumab for up to a further 18 months, if it’s working.
Pembrolizumab is a relatively new addition to the armoury for TNBC, its authorisation for early stage TNBC only arrived last summer, too late for my diagnosis in February 2022. It has a longer track record with melanoma and lung cancer. There have been a plethora of clinical trials for various cancers leading to a cascade of new regulatory approvals in various geographies. It’s currently Merck’s blockbuster drug, comprising about 40% of their global revenues. It earned them $5.8 billion in 1Q23. So there are many, many people on the drug worldwide, even if it’s relatively new for TNBC.
Its mechanism of action is to block the PD-1/PD-L1 pathway that some TNBC tumours use to ‘hide’ from the immune system. By stopping that, in theory your immune system is better able to work with the chemo to destroy the cancer cells. The very scary list of possible side effects is because your body uses the same pathway to create immune privileged zones around your endocrine system and other things, so the therapy can result in your immune system also doing a bit of damage to these things. I went to talk to an oncologist who has 6 years experience working with it for melanoma. She told me it was very well tolerated by most people, and that most problems that do arise can be addressed with steroids. She said it doesn’t work for everyone, but for those ir does, it works spectacularly well.
I decided to trust her. Standard chemo hadn’t worked for me, and I now don’t have other choices. It’s been fine so far.
I have been blogging my ‘journey’ if you are interested in my full story. community.macmillan.org.uk/.../a-trip-with-triple-negative-breast-cancer