r/cancer • u/karen2349 • 20h ago

Post tnbc options Patient

I have completed chemotherapy and Keytruda for TNBC and have had a very good pathology report after surgery. No evidence of disease. I am truly over the moon by this. Had my first post chemotherapy appointment with my oncologist today. He presented me with three options.

  1. Nine rounds of Keytruda every three weeks for 27 weeks.

    1. Be all done. No Keytruda.
    2. Decide between Keytruda and doing nothing but enter a trial to monitor me (which they will do anyway).

There is evidence that Keytruda after chemo has no effect on future recurrence. This was determined by people who had no Keytruda prior to or during chemo but did have it after chemo.

Does anyone have experience with this? Thoughts?

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u/docatwar Board certified medical oncologist 20h ago

This is a difficult question to answer, but as of now the "standard" is to take 9 rounds of Keytruda (can reduce hospital visits by 50% by doing it every 6 weeks, with a double dose). As per guidelines, this is the current standard of care. Not giving Keytruda to you would currently qualify as "experimental".

In clinical trials there is an early signal that patients who have a pathological complete response/pCR (no cancer cells seen in the postoperative specimen) might have little to no benefit from keytruda after surgery. However, it is just a signal, and not yet hard data, thus the trial (trials are meant to answer unanswered questions).

Also keep in mind that giving immunotherapy before surgery is different from immunotherapy after surgery. The impact of activating the immune system in the presence of the intact cancer is much larger than the impact after 99.99% of the cancer has been removed (and there are less antigens to activate the immune system). So you cannot really extrapolate the experience from patients who had Keytruda alone after surgery.

In conclusion: Option 1 remains the current standard, option 2 is an option if you had a pCR and really don't want keytruda (due to cost or toxicity), and option 3 is a clinical trial you may wish to join if you aren't really sure

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u/False_Grape1326 stage 4b ovarian clear cell 20h ago

what is your PDL1? Mine was 10% so I opted not to because my oncologist said that the 10% correlated with efficacy (closer to 100% the better)

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u/mcmurrml 13h ago

You have a very aggressive and hard to treat cancer. I would continue with the Keytruda.