I'm following a 78 year old female with metastatic triple negative breast cancer. After receiving xeloda for 16 months, she progressed and received single agent taxol with good tolerance for 7 months. She elected for treatment break for 3 months. She maintained good quality of life. Recently her pulmonary metastasis is progressing. Biopsy is positive for TNBC with PD-L1 100%. What's your thought on single agent keytruda, vs carboplatin/gemcitabine/keytruda? I'm leaning towards single agent keytruda, due to PD-L1 100%, and to maintain QoL. I noted some phase Ib data for single agent keytruda (PMID: 27138582). Her disease is mainly pulmonary, not very symptomatic, ECOG 1; comorbidities include chronic pain, limited mobility, neuropathy.
Single agent really has low activity in breast. If she hasnt progressed on taxol Id give her the taxol and add pembro to it. If she has then maybe try the combo but I would probably dose reduce the gemzar.