Addition of immunotherapy to chemotherapy for metastatic triple-negative breast cancer: A systematic review and meta-analysis of randomized clinical trials. (December 2021)

• Record Type: Journal Article
• Authors: Huo, Xingfa; Shen, Guoshuang; Liu, Zhen; Liang, Yuhua; Li, Jinming; Zhao, Fuxing; Ren, Dengfeng; Zhao, Jiuda
• Is Part Of: Critical reviews in oncology/hematology. Volume 168(2021)
• Publication Date: 2021-12
• Subjects: Metastatic triple-negative breast cancer -- Immune-checkpoint inhibitor -- Immunotherapy -- Survival -- Pembrolizumab -- Atezolizumab -- Durvalumab; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2021.103530
• Languages: English
• ISSNs: 1040-8428

Abstract

Graphical abstract: Highlights: Question Will the immunotherapy addition to chemotherapy for metastatic triple-negative breast cancer (mTNBC) compared with standalone chemotherapy increased clinical efficacy? Findings This meta-analysis of 4 randomized clinical trials with 3007 patients found that it significantly improved progression-free survival in mTNBC patients with programmed death ligand-1 (PD-L1) positive. Meaning This result may provide more options for the treatment of mTNBC patients with PD-L1 positive. Abstract: Background: One of the front treatment regimens used for metastatic triple-negative breast cancer (mTNBC) is treatment with programmed death-1 (PD-1) or programmed death ligand-1 (PD-L1) blockade combine with chemotherapy. However, the results of such studies have been controversial. Methods: A systematic searched of PubMed, Embase, Cochrane Library, and the proceedings of the last 5 years of several meetings until February 18, 2021. The primary endpoint was the progression-free survival (PFS) of PD-L1-positive patients treated with PD1/PD-L1 blockade plus chemotherapy compare with chemotherapy. Results: Overall, 4 studies that included a total of 3007 mTNBC patients were analyzed in this meta-analysis. PFS was significantly improved in the PD1/PD-L1 blockade plus chemotherapy group compared with the chemotherapy group in PD-L1-positive mTNBC patients (hazard ratios, (HR), 0.69; 95% CI, 0.59–0.80; P < .001), also in intention-to-treat (ITT) population (HR, 0.82; 95% CI, 0.74–0.90; P < .001). However, no significant benefit in overall survival (OS) was observed regardless of PD-L1 status or ITT population. The immunotherapy plus chemotherapy has higher adverse events (AEs) compared with chemotherapy (all AEs, Odds ratios (ORs), 2.33; 95% CI, 1.50–3.62; P < .001; grade 3-5 AEs, OR, 1.27; 95% CI, 1.04–1.55; P = .019). Conclusions: This meta-analysis showed that the addition of PD1/PD-L1 blockade to chemotherapy improved PFS in PD-L1 positive mTNBC patients, also in the ITT population. However, no significant benefit in OS was observed in patients of PD-L1 positive or in the ITT population after adding PD1/PD-L1 blockade. We found a higher rate of AEs with the addition of PD1/PD-L1 blockers to chemotherapy.