A new study has found a way to treat patients with triple-negative breast cancer using a shorter and less toxic treatment plan while achieving similar results to the current standard.
The study, co-led by researchers at UT Southwestern Medical Center, suggests that changing the timing of radiation can reduce the need for chemotherapy and immunotherapy while still being effective.
These findings, published in the Journal of Clinical Oncology, could make cancer treatment less harmful and improve patients’ quality of life.
Triple-negative breast cancer (TNBC) is a rare but aggressive form of breast cancer. It accounts for 10% to 15% of all breast cancer cases. Unlike other types, TNBC cells do not have receptors for estrogen or progesterone and produce little to no HER2 protein.
This makes treatment more difficult because many common breast cancer drugs target these receptors. TNBC tends to grow and spread faster, has fewer treatment options, and has a higher chance of coming back after treatment.
It is also more common in younger women and Black patients. When TNBC spreads beyond the breast, survival rates drop significantly, with life expectancy after metastasis being just 12 to 18 months.
The current standard treatment for TNBC was established in a large global trial called KEYNOTE-522, which involved 1,174 patients across 181 medical centers. This trial combined four chemotherapy drugs with an immunotherapy drug called pembrolizumab before surgery.
After surgery, patients continued taking pembrolizumab for another year. The results were promising—64% of patients had a pathologic complete response, meaning no cancer remained. However, the treatment had serious downsides.
Almost all patients experienced side effects like nausea, vomiting, diarrhea, anemia, and nerve damage. Additionally, the treatment lasted a year, requiring frequent medical visits, which placed a significant burden on patients.
To find a safer alternative, researchers designed a new treatment plan. In this study, 66 breast cancer patients, including 54 with TNBC, received two doses of pembrolizumab and radiation before undergoing chemotherapy.
After that, they had surgery to remove any remaining tumors. Unlike the KEYNOTE-522 trial, chemotherapy was chosen by each patient’s doctor, rather than following a strict combination.
The average age of participants was 53 years, and most of them were white (73%), while 12% were Black, 12% were Asian, and 3% were of other ethnic backgrounds. The researchers followed these patients for an average of 32 months.
The results were encouraging. Among TNBC patients, 59% had a complete response, meaning their cancer disappeared—a rate similar to the KEYNOTE-522 trial. However, the new approach caused far fewer side effects.
Only 41% of patients had severe toxicity, compared to nearly all patients in the previous trial. The shorter treatment also meant fewer doctor visits, reducing stress and improving quality of life for those who responded well.
Dr. Heather McArthur, a lead researcher on the study, explained that giving radiation earlier in the treatment process may help chemotherapy and immunotherapy work better.
This could allow doctors to use lower doses or shorter treatment durations while still achieving good results. Ongoing research at Simmons Cancer Center is exploring other ways to use radiation in cancer treatment.
Review and Analysis
This study provides a promising alternative for TNBC patients, balancing effectiveness with reduced toxicity. The KEYNOTE-522 trial established a strong treatment plan, but its long duration and severe side effects made it difficult for many patients.
The new approach offers similar benefits with less harm, suggesting that adjusting treatment sequences could be an important strategy in cancer therapy.
However, more research is needed before this new method can replace the current standard. The sample size in this trial was relatively small (66 patients compared to over 1,000 in KEYNOTE-522), and long-term survival rates remain unknown.
Future studies with larger groups of patients will help confirm whether this shorter, less toxic treatment is just as effective over time.
Overall, this study is an important step toward making TNBC treatment safer and more manageable. If further trials support these findings, this new approach could significantly improve the quality of life for thousands of breast cancer patients while still delivering strong treatment results.
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The study findings can be found in the Journal of Clinical Oncology.
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