ArticleClinical breast cancer2024
Detrimental Impact of Chemotherapy Dose Reduction or Discontinuation in Early Stage Triple-Negative Breast Cancer Treated With Pembrolizumab and Neoadjuvant Chemotherapy: A Multicenter Experience.
Article in Clinical breast cancer, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Neoadjuvant therapy for stage II-III triple-negative breast cancer: Current evidence, clinical boundaries and emerging strategies (Review).Oncology letters · 2026Review
- Impact of immune-related adverse events on response to neoadjuvant chemoimmunotherapy in triple-negative breast cancer: a single-institution retrospective study.Breast cancer research and treatment · 2026Article
- A Perplexing Plexopathy After Pembrolizumab Therapy in Early-Stage Triple-Negative Breast Cancer.Current oncology (Toronto, Ont.) · 2026Article
- Real-world outcome of neoadjuvant therapy with or without pembrolizumab for triple-negative breast cancer.Acta oncologica (Stockholm, Sweden) · 2026Article
- Immune-Related Adverse Events Associated with Immune Checkpoint Inhibitors: A Scoping Review.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Biomarker-driven neoadjuvant immunotherapy in triple-negative breast cancer: emerging therapeutic targets FOXP3 and WT1.Frontiers in immunology · 2026Review
- Treatment toxicities and pathological response through the evolution of neoadjuvant regimens in early triple-negative breast cancer.ESMO real world data and digital oncology · 2025Article
- Clinicopathological evaluation of triple-negative breast cancer treated with keynote-522 regimen.The oncologist · 2025Article
- Association between neoadjuvant paclitaxel dose intensity and outcomes in early triple-negative and HER2-positive breast cancer: a real-world data analysis.ESMO real world data and digital oncology · 2025Article
- Adverse events in patients treated with neoadjuvant chemo/immunotherapy for triple negative breast cancer: results from seven academic medical centers.Breast cancer research and treatment · 2025Article
- Advancing equitable access to innovation in breast cancer.NPJ breast cancer · 2025Article
- Article
- Treatments of Interest in Male Breast Cancer: An Umbrella Review.Journal of personalized medicine · 2025Review
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Authors and funding
18 authors.
Funding
Abstract
backgroundPembrolizumab combined with neoadjuvant chemotherapy (NAC) is the current standard of care in early stage triple-negative breast cancer (TNBC) based on higher event-free survival and pathological complete response (pCR) in Keynote-522 (KN-522) clinical trial. However, this aggressive five-drug regimen is associated with increased risks for immune-related adverse events (irAEs). We investigated real-world clinical outcomes and toxicity of this regimen as well as factors predictive of pCR and irAEs.
methodsWe identified and abstracted data from 153 early-stage TNBC patients treated with the KN-522 regimen between July 1, 2021, and December 31, 2023, at 4 academic institutions in the U.S. Descriptive analysis was conducted, univariate and multivariate analyses were performed to identify factors associated with pCR and irAEs.
resultsThe median age was 52 years (interquartile range, 42-60years), with 66% White and 24% Black patients with stage I/II (67%), node-negative disease (58%), grade 3 (86%) tumors, and ≥1 comorbidities (68%). Approximately 21% discontinued pembrolizumab, because of toxicity; ∼50% received a lower relative dose intensity (RDI) of chemotherapy (dose reduction or discontinuation). Of the 153 patients, 99 (64.7%) achieved pCR and 83 (54%) experienced an irAE, with 18 (12%) having ≥ grade 3 irAE. The majority (90%) of the irAEs were observed during neoadjuvant phase. Stage I/II versus stage III disease (OR 1.55, CI 1.04-2.33, P = .03), age (OR 0.96, CI 0.93-0.99, P = .01) and full versus reduced RDI of NAC (OR 1.53, CI 1.04-2.26, P = .03) were associated with higher pCR rates on multivariate analyses. Fewer cycles of pembrolizumab were associated with a higher likelihood of irAEs (OR 1.52, CI 1.07-2.16, P = .02), likely explained by the early discontinuation and receipt of less than 8 cycles of pembrolizumab in patients who experienced irAEs.
conclusionsOur study validates the clinical efficacy of KN-522 regimen; however, we observed a higher incidence of irAEs (54%) in this real-world population. Lower stage and younger age were associated with higher likelihood of achieving pCR. Toxicity-related chemotherapy dose reduction or discontinuation was observed to adversely impact the likelihood of achieving pCR.
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