A 41-year-old woman diagnosed with stage IIB triple-negative breast cancer (TNBC) achieved remission following treatment with neoadjuvant pembrolizumab in combination with paclitaxel and carboplatin chemotherapy. The patient, who had no family history of breast cancer, discovered unusual dimpling and thickening in the skin between her right armpit and upper breast, leading to the diagnosis.
Treatment Approach
Initially, the patient consulted with several oncologists, all of whom recommended neoadjuvant chemotherapy followed by a mastectomy and adjuvant radiation therapy. However, Douglas K. Marks, MD, suggested adding pembrolizumab to the neoadjuvant chemotherapy regimen based on a phase III clinical trial. This trial demonstrated that patients with early-stage TNBC who received pembrolizumab plus neoadjuvant chemotherapy had a significantly higher percentage of pathologic complete response compared to those who received a placebo plus neoadjuvant chemotherapy.
The treatment consisted of pembrolizumab combined with paclitaxel and carboplatin. This combination reduced the size of the tumor sufficiently to allow for a lumpectomy instead of a mastectomy. The patient achieved remission and remains cancer-free.
Clinical Significance
The U.S. Food and Drug Administration (FDA) approved pembrolizumab in combination with chemotherapy for advanced triple-negative breast cancer in 2020. In 2021, the FDA expanded the approval to include patients with early-stage disease. This approval was based on data from trials showing improved pathologic complete response rates and survival outcomes with the addition of pembrolizumab to standard chemotherapy regimens.
Patient Perspective
The patient emphasized the importance of seeking information and support from organizations like the Manhasset Women’s Coalition Against Breast Cancer. She also utilized a cold cap scalp cooling system to minimize hair loss during chemotherapy, which helped her maintain a sense of normalcy during treatment. Now nearing the 5-year milestone of remaining cancer-free, she focuses on living each day to the fullest and using her experience to inspire others facing similar challenges.
