Impact of Neoadjuvant Immunochemotherapy on Surgical Outcomes in Management of Early Triple-Negative Breast Cancer
Tamasine Khadrouche1, Mathilde Morisseau2, Gabrielle Selmes1
1Department of Surgical Oncology, Claudius Regaud Institute-IUCT Oncopole, Toulouse, France.
Background:
Triple-negative breast cancer (TNBC) is an aggressive subtype with poor prognosis. Neoadjuvant immunochemotherapy (NAIC) combining chemotherapy and pembrolizumab is now standard for Stage II-III TNBC. This study evaluates the impact of NAIC on surgical outcomes versus neoadjuvant chemotherapy (NAC).
Methods:
A retrospective cohort study included 117 Stage II-III TNBC patients treated with NAIC or NAC (October 2019-May 2023). Surgical complications, time to surgery, time to radiotherapy, and pathologic response were assessed. Complications were classified using the Clavien-Dindo scale; immune-related adverse events (irAEs) followed the 2017 CTCAE criteria.
Results:
Among 117 patients, 59 received NAIC and 58 NAC. Chemotherapy-related adverse events were similar (NAIC: 78.0%, NAC: 75.9%). irAEs occurred in 50.8% of NAIC patients, with 8.5% experiencing severe irAEs. Surgical complications were more frequent in NAIC (27.1%) than NAC (17.2%), though not statistically significant; seroma was the most common. Delays > 12 weeks in initiating radiotherapy were more frequent in NAIC (10.7%) than NAC (0%).
Conclusion:
NAIC did not significantly increase postoperative complications compared to NAC. However, irAEs and potential treatment delays warrant careful management. Despite these risks, NAIC remains a viable option for early TNBC with manageable surgical outcomes.
