Clinical Challenges in Breast Surgery: The Fundamentals of Cancer Immunotherapy

Immune checkpoint inhibitors have rapidly reshaped care for triple-negative breast cancer (TNBC)—but surgical teams increasingly encounter their downstream perioperative consequences. In this episode, we define immunotherapy through the lens of checkpoint biology, review the landmark evidence supporting pembrolizumab in metastatic PD‑L1–positive TNBC (KEYNOTE‑355) and curative-intent stage II–III TNBC (KEYNOTE‑522), and translate immune-related adverse events (irAEs) into practical periop recognition, triage, and timing decisions—especially for endocrine, pulmonary, hepatic, dermatologic, and GI toxicities.

Hosts:
- Rashmi Kumar, MD, PhD
Resident, University of Michigan General Surgery Residency Program 
Twitter/X: @RashmiJKumar
- Melissa Pilewskie, MD
Attending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine
Twitter/X: @MPilewskie
- Stephanie Downs-Canner, MD
Attending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program
Twitter/X: @SDownsCanner

Learning Objectives:

• Define immunotherapy and immune checkpoint inhibition in breast cancer 
• Summarize current clinical indications and pivotal evidence for pembrolizumab in TNBC 
• Equip perioperative clinicians to identify and manage immune-related adverse events (irAEs) or side effects of immunotherapy. 

Rationale for Immunotherapy in Breast Cancer Review

• Selecting Triple Negative Breast Cancer Patients for Immunotherapy: https://pubmed.ncbi.nlm.nih.gov/37714640/
  
  

Landmark Clinical Trials Discussed in this Episode

• KEYNOTE-355: https://pubmed.ncbi.nlm.nih.gov/33232653/
• KEYNOTE-522: https://pubmed.ncbi.nlm.nih.gov/33232642/
• IMpassion130: https://pubmed.ncbi.nlm.nih.gov/30345906/
• IMpassion131: https://pubmed.ncbi.nlm.nih.gov/33930478/

Assessment of Surgical Outcomes in patients receiving chemoimmunotherapy

• Surgical outcomes after neoadjuvant chemoimmunotherapy in triple-negative breast cancer: https://pubmed.ncbi.nlm.nih.gov/38332314/
  
  

Immune Related Adverse Events and Management

• Schneider BJ, et al. Management of immune-related adverse events: https://pubmed.ncbi.nlm.nih.gov/34724392/
• Brahmer JR, et al. SITC clinical practice guideline: https://pubmed.ncbi.nlm.nih.gov/34177534/
  
  

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