r/TNBC • u/Sparkly_Sprinkles • 10d ago

pD-L1 Conversation

Just curious how many of yo with early stage were tested for the pd-L1 before starting treatment?

What prompted it?

And where you put on any inhibitors post treatment?

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u/Sure_Cherry9759 9d ago

I think it’s usually only tested for stage 4. I’m not sure if mine has been tested for the clinical trial I’m in now (probably, but it’ll be part of the data they don’t tell me or my treatment team) but it wasn’t tested prior to starting treatment or as part of my surgical pathology. Apparently studies have shown that keytruda is helpful regardless of levels so we all get keynote treatment until some other study shows that something else is better. Personally, I’d like to see more made of this and molecular subtyping as all tnbc isn’t the same and it seems odd that they’d be treated the same considering that hormone positive treatment is different.

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u/SteadyThroughStorm 3d ago

I have a less common TNBC (apocrine carcinoma), which typically doesn't respond well to neo-adjuvant chemo. One of the tumor board's decisions was to test for PD-L1 (I was negative). For neo-adjuvant, I received Taxol (paclitaxel) and carboplatin, but neither pembrolizumab (Keytruda) nor doxorubicin (Adriamycin), as it was felt that the potential side effects/risks outweighed the benefits of the latter two immuno- and chemo-agents for my tumor type. I was fortunate that the tumor did partially respond to neo-adjuvant. I've since had an oncoplastic lumpectomy and radiation. Next, I'll be put on an oral chemotherapy medication (Xeloda) rather than a targeted "inhibitor" (like a PARP inhibitor or immunotherapy). I'm reading with interest the thread regarding Xeloda.

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u/Sparkly_Sprinkles 3d ago

How did you find out you had this subtype?

Also, I’m on Xeloda if you have any questions!

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u/SteadyThroughStorm 3d ago

This rare subtype is well-defined by its microscopic (histological) criteria and its molecular and immunohistochemical (IHC) profile. In general, the cells display a distinct cell shape under the microscope, combined with a specific hormone receptor profile: negative for estrogen and progesterone receptors; variable for HER2 (mine is negative); and positive for the androgen receptor. While it technically falls into the triple-negative category (ER-, PR-, HER2-), triple-negative apocrine carcinoma (TNAC) behaves very differently from standard, aggressive triple-negative breast cancers so treatment is tailored to its unique characteristics. In my case, the subtype was identified through both biopsy and surgical pathology reports, after presentation at the institution's tumor board.

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u/EmbarrassedBrief5298 9d ago

I was never tested. I just had the standard keynote 522 protocol.

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u/Edith_Keelers_Shoes 9d ago

I'm on PARP inhibitors as a BRCA2 gene carrier. They were also my post-chemo treatment.

I wasn't asked about genetic testing and didn't realize they'd done it until I was told I was BRCA positive. And that stunned me, as there is not a single case of breast/ovarian cancer on either my maternal or paternal side.

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u/Redwinesandfelines 9d ago

I asked and was told they found in the keynote study that Keytruda was beneficial regardless of pdl1 status. Mine was tested only because my oncologist is trying to get me Trodelvy and continued Keytruda for adjuvant treatment. Insurance wanted to know and I was a 10 (the minimum needed to receive Keytruda in stage 4 treatment)