Immune Checkpoint Inhibitors in Elderly Patients With Triple-Negative Breast Cancer: A Systematic Review and...

Immune checkpoint inhibitors (ICIs) have advanced the treatment for triple-negative breast cancer (TNBC), but evidence in older adults remains limited. This study assessed the efficacy and safety of ICIs in elderly patients through a systematic review and meta-analysis of randomized clinical trials METHODS: A systematic search identified trials evaluating ICIs in TNBC. Data from nine studies were pooled using random-effects models. Subgroup analyses examined progression-free survival (PFS) and overall survival (OS) in PD-L1-positive tumors and adults aged ≥65 years.

ICIs improved PFS in the intention-to-treat population (HR 0.69; 95% CI 0.56-0.86; I² = 0%), while OS improvement did not reach statistical significance (HR 0.83; 95% CI 0.69-1.01; I² = 0%). In PD-L1-positive subgroups, pooled results showed reduced mortality risk (OS HR 0.70; 95% CI 0.49-1.01; I² = 28.9%) and a nonsignificant trend toward improvement in PFS (HR 0.71; 95% CI 0.43-1.16; I² = 50.5%). Benefits were consistent in sensitivity analyses and in adults aged 65 years or older. Safety reporting by age was limited, but available data suggest similar rates of immune-related adverse events, although frailty may influence tolerance CONCLUSION: ICIs provide a meaningful PFS benefit in older adults with TNBC, particularly in PD-L1-positive disease, although overall survival improvement represents a numerical trend rather than a statistically confirmed effect. These findings are based on subgroup analyses and should be interpreted cautiously. Future trials should ensure adequate elderly representation, standardized PD-L1 testing, and comprehensive reporting of toxicity and quality-of-life outcomes to optimize treatment decisions in this population.