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. 2024;20(22):1587-1600.
doi: 10.2217/fon-2023-0301. Epub 2024 Apr 10.

Pembrolizumab plus chemotherapy for first-line treatment of advanced triple-negative breast cancer

Amin Haiderali  1 , Min Huang  1 , Wilbur Pan  1 , Katherine G Akers  2 , Dylan Maciel  2 , Andrew M Frederickson  2
Affiliations

Pembrolizumab plus chemotherapy for first-line treatment of advanced triple-negative breast cancer

Amin Haiderali et al. Future Oncol. 2024.

Abstract

Aim: A systematic review and network meta-analysis (NMA) was performed to evaluate the efficacy of first-line treatments for locally recurrent unresectable or metastatic triple-negative breast cancer (TNBC) patients.Materials & methods: Databases were searched for randomized controlled trials evaluating first-line treatments for locally recurrent unresectable or metastatic TNBC patients. NMA was performed to estimate relative treatment effects on overall and progression-free survival between pembrolizumab + chemotherapy and other interventions.Results: NMA including eight trials showed that the relative efficacy of pembrolizumab + chemotherapy was statistically superior to that of other immunotherapy- or chemotherapy-based treatment regimens.Conclusion: Pembrolizumab + chemotherapy confers benefits in survival outcomes versus alternative interventions for the first-line treatment of locally recurrent unresectable or metastatic TNBC patients.

Keywords: PD-1; PD-L1; chemotherapy; immune checkpoint inhibitors; immunotherapy; network meta-analysis; survival outcomes; systematic review; triple-negative breast cancer.

Plain language summary

Clinical value of initial treatments for patients with advanced triple-negative breast cancerWhat is this article about? Around 15% of breast cancer patients have the triple-negative breast cancer (TNBC) subtype, which has the worst prognosis. Treatments targeting the immune system, such as pembrolizumab, were recently found to improve the outcomes of patients with cancer that is at an advanced stage or resistant to standard therapies. However, clinical trials evaluating the efficacy of cancer treatments typically compare only two alternative treatments. Therefore, we conducted this study to understand the relative efficacy of several commonly used initial treatments for advanced TNBC by indirectly comparing the results of all available clinical trials that were sufficiently similar. We identified trials by systematically searching the medical literature and analyzed the results of several clinical trials together to estimate the efficacy of pembrolizumab + chemotherapy compared with several other initial treatment regimens for patients with advanced TNBC.What were the results? We identified eight randomized controlled trials evaluating treatment regimens containing chemotherapeutic or immunotherapeutic agents in patients with previously untreated advanced TNBC. Considering all these trials together, pembrolizumab + chemotherapy was found to prolong patient survival to a greater extent than several other treatment regimens including carboplatin, docetaxel, paclitaxel, nab-paclitaxel/paclitaxel, bevacizumab + paclitaxel, ixabepilone + paclitaxel and ixabepilone + bevacizumab depending on the specific set of trials analyzed.What do the results of the study mean? These results indicate that pembrolizumab + chemotherapy has beneficial effects on patient survival compared with other initial treatment regimens for patients with advanced TNBC.

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Conflict of interest statement

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the study identification and selection process.
Figure 2.
Figure 2.
Evidence networks with KEYNOTE-355 patients assigned to nab-paclitaxel, paclitaxel and gemcitabine/carboplatin analyzed separately (scenario 1). Cohorts of patients receiving nab-paclitaxel (A), paclitaxel (B), or gemcitabine/carboplatin (C) in KEYNOTE-355 were analyzed in separate networks, as these treatments were assumed to have different efficacies. Due to a lack of common comparators, the networks are disconnected.
Figure 3.
Figure 3.
Evidence network with KEYNOTE-355 patients assigned to paclitaxel and nab-paclitaxel analyzed together (scenario 2). Nab-paclitaxel and paclitaxel are assumed to have the same efficacy, thus cohorts of patients receiving these treatments in KEYNOTE-355 were analyzed in the same network.
See this image and copyright information in PMC

References

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    2. • Uses GLOBOCAN 2020 data to estimate the global burden of cancer, including the incidence and mortality rate of breast cancer.

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