新辅助性免疫检查点抑制剂加化学疗法在早期乳腺癌:一个系统性审查和元分析
Guillermo Villacampa1,2, Victor Navarro2, Alexios Matikas3,4
1SOLTI Cancer Research Group, Barcelona, Spain.
JAMA oncology
|August 29, 2024
概括
新辅助性免疫检查点抑制剂改善了早期乳腺癌的结果,特别是三阴性和PD-L1+ HR+/ERBB2-亚型. 辅助性ICI没有显示任何益处,进一步的研究应该确定最有可能受益的患者.
科学领域:
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
- 临床试验 临床试验
背景情况:
- 研究免疫检查点抑制剂 (ICI) 与早期乳腺癌的新辅助化疗的组合至关重要.
- 在这种情况下,ICI的最佳整合策略仍在讨论中.
研究的目的:
- 评估新辅助性ICI与分子乳腺癌亚型的病理完整反应 (pCR) 之间的关联.
- 量化ICI超越pCR的生存益处,并估计不良事件发生率.
主要方法:
- 在2023年12月10日进行了PubMed的系统文献搜索.
- 包括随机临床试验 (RCT) 评估 (新) 辅助性ICI加化疗在早期乳腺癌.
- 进行了个体患者数据和试验水平的元分析,以估计pCR和无事件生存期 (EFS) 等结果.
主要成果:
- 新辅助剂ICI改善了三阴性乳腺癌 (TNBC) 和PD-L1阳性激素受体阳性/ERBB2阴性 (HR+/ERBB2-) 瘤中的pCR.
- 在获得pCR的TNBC患者中,ICI改善了EFS (HR,0.65);在残留疾病患者中也出现了类似的好处 (HR,0.77).
- 辅助性ICI没有改善结果,3级+免疫相关不良事件在新辅助治疗期间发生在10.3%的患者中.
结论:
- 新辅助性ICI治疗增强了早期TNBC和PD-L1+HR+/ERBB2-乳腺癌的疗效,具有可接受的安全性.
- 辅助性ICI没有显示任何益处,强调了治疗时间的重要性.
- 未来的研究应该专注于确定最有可能从新辅助性ICI加化疗中受益的患者群体.
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