Pembrolizumab plus chemotherapy for first-line treatment of advanced triple-negative breast cancer
Creators: name: Haiderali, Amin
name: Huang, Min
name: Pan, Wilbur
name: Akers, Katherine G
name: Maciel, Dylan
name: Frederickson, Andrew M
Publisher: name: Taylor & Francis
Year: 2024
Subjects: Medicine
Biotechnology
Environmental Sciences not elsewhere classified
Biological Sciences not elsewhere classified
Cancer
Science Policy

description: <b>Aim:</b> 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. <b>Materials &amp; methods:</b> 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. <b>Results:</b> 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. <b>Conclusion:</b> Pembrolizumab + chemotherapy confers benefits in survival outcomes versus alternative interventions for the first-line treatment of locally recurrent unresectable or metastatic TNBC patients. <b>Clinical value of initial treatments for patients with advanced triple-negative breast cancer</b> 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. 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. These results indicate that pembrolizumab + chemotherapy has beneficial effects on patient survival compared with other initial treatment regimens for patients with advanced TNBC. Pembrolizumab + chemotherapy confers benefits in survival outcomes versus alternative interventions for the first-line treatment of locally recurrent unresectable or metastatic TNBC patients. Patients with triple-negative breast cancer (TNBC) have the worst prognosis among all breast cancer patients. Pembrolizumab + chemotherapy was recently shown to improve the survival of patients with advanced cancers or cancers refractory to standard treatments, with promising results for the treatment of breast cancer. The purpose of this study was to compare the relative efficacy of pembrolizumab + chemotherapy to other interventions for the first-line treatment of locally recurrent unresectable or metastatic TNBC through a systematic review and network meta-analysis. EMBASE, MEDLINE, CENTRAL, conference abstracts and clinical trial registries were searched for randomized controlled trials evaluating immunotherapy- or chemotherapy-based treatments for patients with locally recurrent unresectable or metastatic TNBC who were previously untreated for advanced disease. Following study screening and feasibility assessment, eight unique trials were included in the network meta-analysis. In terms of overall survival, the relative treatment efficacy of pembrolizumab + different chemotherapy agents was statistically superior to that of carboplatin, docetaxel, paclitaxel, bevacizumab + paclitaxel, ixabepilone + paclitaxel or ixabepilone + bevacizumab depending on the evidence network analyzed. In terms of progression-free survival, the relative treatment efficacy of pembrolizumab + different chemotherapy agents was statistically superior to that of paclitaxel or nab-paclitaxel/paclitaxel combined depending on the evidence network analyzed. These results suggest that as a first-line treatment for locally recurrent unresectable or metastatic TNBC, pembrolizumab + chemotherapy is more efficacious in improving survival outcomes compared with other interventions, with greater improvements observed for overall survival than for progression-free survival.