Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

BackgroundImmune checkpoint inhibitors (ICIs) have shown promising anti-tumor activity in multiple malignances including breast cancer. However, the responses can vary. This meta-analysis was conducted to evaluate the efficacy and safety profile of adding ICIs to neoadjuvant chemotherapy against tri...

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Autores principales:	Yunhai Li, Lei Xing, Fan Li, Hong Liu, Lu Gan, Dejuan Yang, Mengxue Wang, Xuedong Yin, Hongyuan Li, Guosheng Ren
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	triple-negative breast cancer (TNBC) neoadjuvant chemotherapy immune checkpoint inhibitors (ICI) pathological complete response meta-analysis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/495d767440f04a549b2f028fa8b85695
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spelling	oai:doaj.org-article:495d767440f04a549b2f028fa8b856952021-12-01T14:03:03ZEfficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials2234-943X10.3389/fonc.2021.657634https://doaj.org/article/495d767440f04a549b2f028fa8b856952021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.657634/fullhttps://doaj.org/toc/2234-943XBackgroundImmune checkpoint inhibitors (ICIs) have shown promising anti-tumor activity in multiple malignances including breast cancer. However, the responses can vary. This meta-analysis was conducted to evaluate the efficacy and safety profile of adding ICIs to neoadjuvant chemotherapy against triple-negative breast cancer (TNBC) and assess correlation of PD-L1 tumor status with responses.MethodsEligible studies were retrieved from the PubMed, Embase, and Web of Science databases. Randomized controlled trials (RCTs) that investigated ICI-containing versus ICI-free neoadjuvant therapy were included in this study. Meta-analyses were performed using Review Manager Version 5.2 software.ResultsThis study included four RCTs containing 1795 patients with early TNBC. Compared with ICI-free neoadjuvant therapy, ICI-containing neoadjuvant therapy significantly increased the pathological complete response (pCR) rates in TNBC (odds ratio [OR] = 2.14, 95% confidence interval [CI]: 1.37–3.35, P < 0.001). In subgroup analysis, the addition of ICI to neoadjuvant chemotherapy was significantly associated with increased pCR rate in both PD-L1-positive TNBC (OR = 1.79, 95% CI: 1.33–2.41, P < 0.001) and PD-L1-negative TNBC (OR = 1.84, 95% CI: 1.14–2.99, P = 0.01). Patients with TNBC receiving ICI-containing neoadjuvant therapy had a better event-free survival (hazard ratio = 0.66, 95% CI: 0.48–0.89, P = 0.007) than those who receiving ICI-free neoadjuvant therapy. A significantly higher risk of adverse events including adrenal insufficiency, increased aspartate aminotransferase, dry skin, hepatitis, hyperthyroidism, hypothyroidism, infusion related reaction, pyrexia, and stomatitis was associated with ICI-containing neoadjuvant therapy.ConclusionICI-containing neoadjuvant therapy significantly increased the pCR rate in TNBC patients, independently of PD-L1 status. The addition of ICI to neoadjuvant chemotherapy may be considered an option for TNBC patients.Yunhai LiLei XingFan LiHong LiuLu GanDejuan YangMengxue WangXuedong YinHongyuan LiGuosheng RenGuosheng RenFrontiers Media S.A.articletriple-negative breast cancer (TNBC)neoadjuvant chemotherapyimmune checkpoint inhibitors (ICI)pathological complete responsemeta-analysisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	triple-negative breast cancer (TNBC) neoadjuvant chemotherapy immune checkpoint inhibitors (ICI) pathological complete response meta-analysis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	triple-negative breast cancer (TNBC) neoadjuvant chemotherapy immune checkpoint inhibitors (ICI) pathological complete response meta-analysis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Yunhai Li Lei Xing Fan Li Hong Liu Lu Gan Dejuan Yang Mengxue Wang Xuedong Yin Hongyuan Li Guosheng Ren Guosheng Ren Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
description	BackgroundImmune checkpoint inhibitors (ICIs) have shown promising anti-tumor activity in multiple malignances including breast cancer. However, the responses can vary. This meta-analysis was conducted to evaluate the efficacy and safety profile of adding ICIs to neoadjuvant chemotherapy against triple-negative breast cancer (TNBC) and assess correlation of PD-L1 tumor status with responses.MethodsEligible studies were retrieved from the PubMed, Embase, and Web of Science databases. Randomized controlled trials (RCTs) that investigated ICI-containing versus ICI-free neoadjuvant therapy were included in this study. Meta-analyses were performed using Review Manager Version 5.2 software.ResultsThis study included four RCTs containing 1795 patients with early TNBC. Compared with ICI-free neoadjuvant therapy, ICI-containing neoadjuvant therapy significantly increased the pathological complete response (pCR) rates in TNBC (odds ratio [OR] = 2.14, 95% confidence interval [CI]: 1.37–3.35, P < 0.001). In subgroup analysis, the addition of ICI to neoadjuvant chemotherapy was significantly associated with increased pCR rate in both PD-L1-positive TNBC (OR = 1.79, 95% CI: 1.33–2.41, P < 0.001) and PD-L1-negative TNBC (OR = 1.84, 95% CI: 1.14–2.99, P = 0.01). Patients with TNBC receiving ICI-containing neoadjuvant therapy had a better event-free survival (hazard ratio = 0.66, 95% CI: 0.48–0.89, P = 0.007) than those who receiving ICI-free neoadjuvant therapy. A significantly higher risk of adverse events including adrenal insufficiency, increased aspartate aminotransferase, dry skin, hepatitis, hyperthyroidism, hypothyroidism, infusion related reaction, pyrexia, and stomatitis was associated with ICI-containing neoadjuvant therapy.ConclusionICI-containing neoadjuvant therapy significantly increased the pCR rate in TNBC patients, independently of PD-L1 status. The addition of ICI to neoadjuvant chemotherapy may be considered an option for TNBC patients.
format	article
author	Yunhai Li Lei Xing Fan Li Hong Liu Lu Gan Dejuan Yang Mengxue Wang Xuedong Yin Hongyuan Li Guosheng Ren Guosheng Ren
author_facet	Yunhai Li Lei Xing Fan Li Hong Liu Lu Gan Dejuan Yang Mengxue Wang Xuedong Yin Hongyuan Li Guosheng Ren Guosheng Ren
author_sort	Yunhai Li
title	Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_short	Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_full	Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_fullStr	Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed	Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_sort	efficacy and safety of adding immune checkpoint inhibitors to neoadjuvant chemotherapy against triple-negative breast cancer: a meta-analysis of randomized controlled trials
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/495d767440f04a549b2f028fa8b85695
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Efficacy and Safety of Adding Immune Checkpoint Inhibitors to Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

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