Comparative effectiveness and safety of neoadjuvant chemotherapy in combination with pembrolizumab for triple negative breast cancer: A real-world analysis from Alberta, Canada.
Notice bibliographique
Résumé
e12629 Background: The KEYNOTE-522 trial demonstrated improved pathologic complete response (pCR) rate and longer-term survival outcomes with the addition of pembrolizumab to neoadjuvant chemotherapy (NAC) which included taxane, carboplatin and anthracycline (TCbA) in patients with stage II/III triple negative breast cancer (TNBC). In Alberta, the KEYNOTE-522 protocol was adopted as standard of care by January 2023. This replaced NAC that routinely included taxane and anthracycline (TA) without carboplatin. This retrospective study describes the real-world clinical impact of adding pembrolizumab and carboplatin to neoadjuvant TA in patients with stage II/III TNBC in Alberta. Methods: The cohort was identified by Alberta Health Services Cancer Research & Analytics and clinical variables were retrieved from electronic medical records.We identified all patients diagnosed with stage II/III TNBC from November 2020 to November 2023 in Alberta, treated with either neoadjuvant TA or TCbA + pembrolizumab, and had undergone surgical resection by June 1, 2024. The primary outcome was rate of pCR. Secondary outcomes included rate of breast conserving surgery (BCS) vs mastectomy, rate of axillary lymph node dissection (ALND) vs sentinel node biopsy, and safety outcomes during the neoadjuvant phase including hospitalizations, emergency visits, and immunotherapy-related adverse events (irAEs). Results: Of the 248 eligible women, 110 were treated with TA and 138 were treated with TCbA + pembrolizumab. There were no differences in clinicopathologic and treatment factors between the groups. Women treated with TCbA + pembrolizumab compared to those treated with TA, had a significant increase in pCR rate of 32% (63.8% vs 31.8%, p < .0001) and BCS rate of 14.7% (56.5% vs 41.8%, p = 0.001) with corresponding 25.5% decrease in the rate of ALND (15.5% vs. 40%, < .0001). Women treated with TCbA + pembrolizumab compared to those with TA, were 16.2% more likely to visit ER (47.1% vs 30.9%, p = 0.009), and 16.1% more likely to be admitted to hospital (22.5% vs 6.4%, p = 0.0005) during the neoadjuvant phase. Among the 138 patients with pembrolizumab, 35 (25.4%) patients developed 46 separate irAEs in the neoadjuvant phase. The most common irAEs related systems were endocrinopathies (32.6%), GI (23%), cutaneous (10.9%), and lung (9%). Conclusions: In this real-world study of stage II/III TNBC, the pCR rate for neoadjuvant TCbA + pembrolizumab was comparable to the intervention arm in KEYNOTE-522 and was significantly improved compared to patients who received TA only. The increased pCR rate corresponded to a higher rate of BCS and lower rate of ALND. Adoption of the KEYNOTE-522 protocol was however associated with significant increased toxicity and use of health care resources, underpinning the need for close clinical management of these patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».