At the 2019 American Society of Clinical Oncology Annual Meeting in Chicago, Lisa Carey, MD, moderated a panel titled “Optimizing Patient Outcomes in Metastatic, Triple-Negative Breast Cancer,” a continuing education program for medical experts developed by WebMD Education/Medscape Education, Living Beyond Breast Cancer, and Triple Negative Breast Cancer Foundation. The program is hosted on medscape.org, with CEUs available.

At ASCO 2019 we brought together two medical oncology experts to discuss the management of metastatic, triple-negative breast cancer: Nancy Lin, MD, of Dana-Farber, and Tiffany Traina, MD, of Memorial Sloan-Kettering. We focused on case-based challenges facing all of us in the clinic. 

Examples of clinical challenges we discussed include how to sequence and decide among chemotherapy options versus PARP inhibition in metastatic BRCA-associated cancer, and the implication of prior platinum treatment in that setting. We reviewed the data from olaparib (Lynparza) and talazoparib (Talzenna) trials, now that both drugs are approved in this setting. 

A number of questions arose around treatment in the first-line setting, including the best tissue to test for PD-L1, identification and management of immune checkpoint inhibitor toxicity, where we thought the field was going regarding chemotherapy and other combinations with PD1/PD-L1 inhibitors, and when to use doublet versus single-agent chemotherapy.

Decision-making in the second- and later-line settings can be difficult given the absence of non-cytotoxic options. Dr. Nancy Lin gave thoughtful insight into those decisions. We discussed as a group some of the exciting new non-cytotoxic agents being developed in triple-negative disease, and where we thought this field would go in the next few years.

Finally, when and how to approach patients for clinical trials and for transition to palliative care is a longstanding question and a skill set that these experts have thought long and hard about. We reviewed some of these issues as well as the resources available for patients, such as Living Beyond Breast Cancer at LBBC.ORG and the Triple Negative Breast Cancer Foundation at tnbcfoundation.org, both sites that have up-to-date, medically vetted information about FDA-approved treatments used in metastatic, triple-negative breast cancer as well as information about clinical trials, side effects, and psychosocial and practical issues important for patients to be able to access.

It was a fascinating program and one that I believe both providers and patients will benefit greatly from.

This program was created by a partnership of Living Beyond Breast Cancer, WebMD/Medscape Education, and our peer organization SHARE. It is available for continuing education credits at Medscape’s website.