TNBC Stage 1 Grade 3 which treatment?

Hi TNBCG 

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

Same diagnosis but I believe it depends on the size and location for me it was surgery and sentinel node removal for biopsy to check it's all gone don't know till 20th June opp was may 13th

Hi. I wasn't given a choice and was automatically given the second regime. Im also grade 3 with 3 LN involvement. I started cycle 3 last week and have been absolutely fine throughout on it, albeit a bit of fatigue and low white blood cells which i self-inject for. The consultant told me at my last appt that my tumour has shrunk from 2.8cm to 1.5cm. I have researched immunotherapy after hearing about it being new etc and side effects and for me, the benefits outweigh the negatives. Plus, they really watch closely for any side effects so they are dealt with before causing any damage. I actually feel lucky to be able to have it. I hope whatever plan you decide, it all runs smoothly xx