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Meta-Analysis
. 2022 Feb;22(2):229-235.
doi: 10.1080/14737140.2022.2023011. Epub 2022 Jan 24.

Atezolizumab and pembrolizumab in triple-negative breast cancer: a meta-analysis

Farah Latif  1 , Hira Bint Abdul Jabbar  2 , Hamna Malik  3 , Humaira Sadaf  4 , Azza Sarfraz  5 , Zouina Sarfraz  1 , Ivan Cherrez-Ojeda  6
Affiliations
Meta-Analysis

Atezolizumab and pembrolizumab in triple-negative breast cancer: a meta-analysis

Farah Latif et al. Expert Rev Anticancer Ther. 2022 Feb.

Abstract

Background: The approval of anti-PD-L1 drugs, including atezolizumab/pembrolizumab in triple-negative breast cancer (TNBC), potentially improveme treatment regimens available for TNBC.

Methods: We conducted a meta-analysis to review the efficacy of atezolizumab/pembrolizumab for the treatment of TNBC in both the adjuvant and neoadjuvant settings. We calculated standardized mean difference (SMD) for the associations of progression-free survival (PFS) and overall survival (OS) and odds ratios (ORs) to estimate objective response rate (ORR) and pathological complete response (pCR), using 95% confidence intervals (CIs).

Results: Six clinical trials comprising 3612 patients were included. For adjuvant therapies, the ORR (OR = 1.26, P = 0.04) of atezolizumab/pembrolizumab plus chemotherapy was higher in the intention to treat (ITT) arms than the placebo groups in TNBC. A positive effect size was found for PFS in the ITT arms (d = 1.55, P < 0.001). The atezolizumab plus chemotherapy group had a positive effect size for OS compared to control groups (d = 0.52, P < 0.001). In the neoadjuvant setting, patients in ITT arms had higher pCR rates than the control groups (OR = 1.61, P = 0.001).

Conclusion: We collate evidence of atezolizumab/pembrolizumab as viable therapeutics among patients with TNBC with PD-L1 subgroups deriving higher benefits.

Keywords: Triple-negative breast cancer; anti-PD-L1; atezolizumab; biomarkers; chemotherapy; development of novel drugs; pembrolizumab; targeted therapies.

Plain language summary

PLAIN LANGUAGE SUMMARYImmune checkpoint inhibitors (ICI), atezolizumab and pembrolizumab, have received approval for patients with triple-negative breast cancer (TNBC) expressing PD-L1. Thus far, it has only been approved for patients with unresectable locally advanced or metastatic TNBC. With the IMpassion 130 and KEYNOTE-355 trials introducing the immunotherapy era for TNBC, ongoing trials have started exploring the outcomes of the ICIs in early-stage TNBC in combination. Recently, the ICIs have demonstrated positive efficacy outcomes in neoadjuvant settings. Both the ICIs have shown a safe profile in terms of adverse events. The recent advances made by clinical trials indicate promising results for early-stage and advanced/metastatic TNBC. However, there is a need to harmonize and explore biomarkers and endpoints in the ongoing clinical trials to enhance patient treatment protocols. As TNBC is an aggressive subtype, exploring beyond the PD-L1 positive subgroup is necessary to expand the target population receiving ICIs for TNBC.

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