Results of the Alexandra/IMpassion030 study: Prof François Duhoux meets Prof Michail Ignatiadis

Prof Michail Ignatiadis, director of the Breast Medical Oncology Clinic at Institut Jules Bordet, Brussels, discusses with his colleague Prof François Duhoux, medical oncologist and head of clinic of the department of oncology at the Cliniques Universitaires in Brussels, on his presentation during the general session 1 at San Antionio, in which Prof Ignatiadis communicated the results of the ALEXANDRA/IMpassion030 trial.

The ALEXANDRA/IMpassion030 trial, a phase 3 study, investigated adjuvant atezolizumab in patients who completed primary surgery for stage 2 or 3 triple-negative breast cancer. The trial randomized patients between adjuvant atezolizumab with chemotherapy and chemotherapy alone, with the primary endpoint being IDFS. The results, presented after a median follow-up of 25 months, showed a negative outcome, as the hazard ratio for IDFS was 1.12, crossing the futility boundary.

In terms of safety, atezolizumab demonstrated a profile consistent with prior trials, with no new safety signals. Additionally, the addition of atezolizumab did not compromise the delivery of standard-of-care adjuvant chemotherapy.

Caution is urged in extrapolating these results to patients who received neoadjuvant chemotherapy upfront, as the ALEXANDRA/IMpassion030 trial focused on a different setting. The trial’s contribution lies in enhancing the understanding of optimal immunotherapy use in early triple-negative breast cancer. The conclusion drawn is that adjuvant immunotherapy has no place for patients who undergo upfront surgery. The study reinforces the preference for neoadjuvant regimens for triple-negative breast cancer treatment and provides valuable insights into managing adjuvant settings in the absence of pCR.

In the discussion, it was emphasised that the trial’s results don’t necessarily influence the use of immunotherapy in the neoadjuvant setting, as the ALEXANDRA/IMpassion030 trial focused on adjuvant therapy.

Reference:

Ignatiadis M. et al., Adding atezolizumab to adjuvant chemotherapy for stage II and III triple-negative breast cancer is unlikely to improve efficacy: interim analysis of the ALEXANDRA/IMpassion030 phase 3 trial. –   SABCS 2023, #GS01-02