PMID- 34814874
OWN - NLM
STAT- MEDLINE
DCOM- 20220221
LR  - 20240404
IS  - 1471-2407 (Electronic)
IS  - 1471-2407 (Linking)
VI  - 21
IP  - 1
DP  - 2021 Nov 23
TI  - Immune checkpoint inhibitors plus neoadjuvant chemotherapy in early 
      triple-negative breast cancer: a systematic review and meta-analysis.
PG  - 1261
LID - 10.1186/s12885-021-08997-w [doi]
LID - 1261
AB  - PURPOSE: Some studies have shown that Immune checkpoint inhibitors (ICIs) have a 
      favorable efficacy in advanced triple negative breast cancer (TNBC) patients, but 
      the results are controversial in neoadjuvant chemotherapy (NACT) stage. The 
      purpose of this study is to evaluate the efficacy and safety after NACT plus ICIs 
      in early TNBC patients. METHODS: After searching PubMed, EMBASE, the Cochrane 
      library and several mainly oncology conferences up to 30 January 2021 
      systematically, and define randomized controlled trials (RCTs) exploring the 
      efficacy and safety of programmed death protein-1/programmed cell death-Ligand 
      1(PD-1/PD-L1) inhibitors plus neoadjuvant chemotherapy in TNBC patients. The 
      primary endpoint was the pathological complete response (pCR) in 
      intention-to-treat populations (ITT), and the secondary endpoints were event-free 
      survival (EFS) and safety analysis in the ITT populations. RESULTS: Six RCTs 
      (N = 2142) were included in our meta-analysis; NACT plus ICIs increased pCR rates 
      compared with NACT in intention-to-treat (ITT) populations (OR: 1.91; 95% CI: 
      1.32-2.78, P < 0.001). The pCR rate also increased in both PD-L1 positive (OR: 
      1.65; 95% CI: 1.26-2.16, P < 0.001) and PD-L1 negative patients (OR: 1.56; 95% 
      CI: 1.04-2.33, P = 0.03), especially in PD-L1 positive patients. The benefit was 
      also observed in nodal-positive populations (OR: 2.52; 95% CI: 1.69-3.77, 
      P < 0.001) and Eastern Cooperative Oncology Group performance-status score (ECOG 
      PS) 0 subgroup (OR: 1.90; 95% CI: 1.42-2.53, P < 0.001). Three RCTs (N = 1615) 
      reported EFS and the results showed that adding PD-1/PD-L1 inhibitors increased 
      EFS (HR 0.65, 95% CI 0.50-0.83, P = 0.0007) in ITT populations with a short 
      follow-up time. In the safety analysis of 2205 patients with early TNBC from five 
      eligible studies, NACT plus ICIs had a higher risk of grade 3-4 diarrhea (OR: 
      2.54; 95% CI: 1.21-5.32; P = 0.01), any grade of adverse effects(AEs)including 
      vomiting (OR: 1.37; 95% CI: 1.00-1.86; P = 0.05), hyperthyroidism (OR: 6.04; 95% 
      CI: 2.39-15.29; P < 0.001), and hypothyroidism (OR: 5.04; 95% CI: 3.02-8.39; 
      P < 0.001). CONCLUSIONS: PD-1/PD-L1 inhibitors combined with chemotherapy can 
      improve pCR rates and EFS, and with an increased incidence of some immune-related 
      AEs compared with chemotherapy alone. NACT plus ICIs might be an option in 
      patients with in PD-L1 positive and high-risk populations with positive nodal 
      disease early TNBC.
CI  - (c) 2021. The Author(s).
FAU - Xin, Yuanfang
AU  - Xin Y
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China. xyf2522@126.com.
FAU - Shen, Guoshuang
AU  - Shen G
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China. guoshuangshen@126.com.
FAU - Zheng, Yonghui
AU  - Zheng Y
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China. yonghui110723@126.com.
FAU - Guan, Yumei
AU  - Guan Y
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Huo, Xingfa
AU  - Huo X
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Li, Jinming
AU  - Li J
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Ren, Dengfeng
AU  - Ren D
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Zhao, Fuxing
AU  - Zhao F
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Liu, Zhen
AU  - Liu Z
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Li, Zitao
AU  - Li Z
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China.
FAU - Zhao, Jiuda
AU  - Zhao J
AD  - Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai 
      University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, 
      China. jiudazhao@126.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20211123
PL  - England
TA  - BMC Cancer
JT  - BMC cancer
JID - 100967800
RN  - 0 (Immune Checkpoint Inhibitors)
SB  - IM
MH  - Female
MH  - Humans
MH  - Chemotherapy, Adjuvant
MH  - Diarrhea/chemically induced
MH  - Hyperthyroidism/chemically induced
MH  - Hypothyroidism/chemically induced
MH  - *Immune Checkpoint Inhibitors/adverse effects/therapeutic use
MH  - Intention to Treat Analysis
MH  - *Neoadjuvant Therapy/adverse effects/methods
MH  - Progression-Free Survival
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - *Triple Negative Breast Neoplasms/drug therapy/pathology
MH  - Vomiting/chemically induced
PMC - PMC8609839
OTO - NOTNLM
OT  - Neoadjuvant chemotherapy
OT  - PD-1/PD-L1 inhibitors
OT  - Triple-negative breast cancer
COIS- The authors declare that they have no competing interests
EDAT- 2021/11/25 06:00
MHDA- 2022/02/22 06:00
PMCR- 2021/11/23
CRDT- 2021/11/24 05:33
PHST- 2021/06/30 00:00 [received]
PHST- 2021/11/10 00:00 [accepted]
PHST- 2021/11/24 05:33 [entrez]
PHST- 2021/11/25 06:00 [pubmed]
PHST- 2022/02/22 06:00 [medline]
PHST- 2021/11/23 00:00 [pmc-release]
AID - 10.1186/s12885-021-08997-w [pii]
AID - 8997 [pii]
AID - 10.1186/s12885-021-08997-w [doi]
PST - epublish
SO  - BMC Cancer. 2021 Nov 23;21(1):1261. doi: 10.1186/s12885-021-08997-w.