{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T19:13:10Z","timestamp":1793128390424,"version":"4.5.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n Although adding immune checkpoint inhibitors to neoadjuvant chemotherapy improves outcomes in high-risk early-stage breast cancer, opportunities remain to further enhance response. Dual checkpoint blockade offers a potential strategy to further enhance efficacy.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To evaluate the combination of anti\u2212programmed cell death 1 protein (PD-1) cemiplimab and anti\u2212lymphocyte activation gene 3 (LAG-3) added to neoadjuvant therapy in\n ERBB2<\/jats:italic>\n -negative early-stage, high-risk breast cancer.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n The I-SPY2 (Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis 2) is an ongoing randomized clinical platform trial being conducted at multiple US clinical sites including patients with early-stage (II or III)\n ERBB2<\/jats:italic>\n -negative, high-risk breast cancer. Participants, continuously enrolled since 2010, were adaptively randomized from February 2, 2020, to December 9, 2021, to one of several experimental neoadjuvant therapies or control groups based on receptor subtypes defined by hormone receptor (HR),\n ERBB2<\/jats:italic>\n status, and MammaPrint (Agendia Inc) molecular risk, categorized as high (MP1) or ultrahigh (MP2). Data were analyzed from January 1, 2022, to August 5, 2025.\n <\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Both groups received weekly paclitaxel for 12 weeks, then doxorubicin and cyclophosphamide followed by surgery; concomitant with paclitaxel, the intervention group also received 4 doses of cemiplimab and fianlimab (PCF) every 3 weeks.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Pathologic complete response (pCR). Treatments graduated when they achieved 85% bayesian probability of success in a subtype-specific phase 3 trial. Pathway-specific biomarkers were assessed for response prediction.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 78 participants (mean [SD] age, 47 [39-54] years) were randomized to the intervention group, with 350 participants (mean [SD] age, 48 [39-57] years) randomized to the historical control population. PCF graduated in all clinical signatures, with pCR rates vs control of 44% (95% CI, 34%-53%) vs 21% (95% CI, 17%-25%) in all\n ERBB2<\/jats:italic>\n , 53% (95% CI, 39%-67%) vs 29% (95% CI, 22%-36%) in triple-negative, and 36% (95% CI, 23%-49%) vs 14% (95% CI, 9%-19%) in HR-positive and\n ERBB2<\/jats:italic>\n -negative disease. Among the total participants, 16 (21%) experienced adrenal insufficiency, including hypophysitis (11% grade 3 or 4), mostly occurring after immunotherapy completion. PCF was found to be highly effective in the subset of patients with immune signature positive status (ImPrint positive).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this randomized clinical trial, the combination of PD-1 and anti\u2212LAG-3 inhibition with standard NAC was effective in early-stage\n ERBB2<\/jats:italic>\n -negative breast cancer, particularly in patients displaying a positive ImPrint immune signature. These results warrant further definitive trials.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT01042379<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoncol.2026.2576","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:30:30Z","timestamp":1785425430000},"page":"1008","source":"Crossref","is-referenced-by-count":1,"title":["Cemiplimab and Fianlimab With Neoadjuvant Chemotherapy in Early-Stage High-Risk\n ERBB2<\/i>\n -Negative Breast Cancer"],"prefix":"10.1001","volume":"12","author":[{"given":"Claudine","family":"Isaacs","sequence":"first","affiliation":[{"name":"Department of Medicine, Lombardi Comprehensive Cancer Center Georgetown University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Nanda","sequence":"additional","affiliation":[{"name":"Department of Breast Medical Oncology, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Yau","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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