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, PhDResident, University of Michigan General Surgery Residency Program Twitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan MedicineTwitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training ProgramTwitter/X: @SDownsCannerLearning 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 ReviewSelecting 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 chemoimmunotherapySurgical 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/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://b