Journal Article

Assessment of the safety and efficacy of combination chemotherapy and PD-1/PD-L1 inhibitor treatment of breast cancer: A meta-analysis

Qian, Da, Xu, Yuhao, Hong, Weimin, Wu, Yihao, Meng, Xuli, Qiu, Jie

2023

Overview

As the efficacy of programmed cell death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors combined with chemotherapy in curing breast cancer is still controversial, this meta-analysis compares the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy and chemotherapy alone in the treatment of breast cancer, which provides guidance for the clinical treatment. Relevant studies published as of April 2022 in the various databases including EMBASE, PubMed, and Cochrane Library were selected. Randomized controlled trials (RCTs) in which control patients underwent chemotherapy alone and experimental group patients underwent combination chemotherapy and PD-1/PD-L1 inhibitor treatment were included in this investigation. Investigations without complete information, researches from which information could not be extracted, duplicate articles, animal studies, review articles, and systematic reviews were excluded. STATA 15.1 was employed for all statistical analyses. In total, eight eligible studies were identified, revealing that combination chemotherapy and PD-1/PD-L1 inhibitor treatment was linked to significant increases in progression-free survival (PFS) relative to chemotherapy alone (hazard ratio [HR] = 0.83, 95% confidence interval [CI]: 0.70-0.99, P = 0.032) but not overall survival (HR = 0.92, 95% CI: 0.80-1.06, P = 0.273). Pooled adverse event rates were also increased within the group of combination treatment relative to the chemotherapy group (risk ratio [RR] = 1.08, 95% CI: 1.03-1.14, P = 0.002). Specifically, nausea rates were lesser within the group of combination treatment relative to the group of chemotherapy (RR = 0.48, 95% CI: 0.25-0.92, P = 0.026). Subgroup analyses indicated that the PFS of patients who underwent combination atezolizumab or pembrolizumab and chemotherapy treatment were substantially longer than those of patients who underwent chemotherapy alone (HR = 0.79, 95% CI: 0.69-0.89, P ≤0.001; HR = 0.79, 95% CI: 0.67-0.92, P = 0.002). The pooled results suggest that combination chemotherapy and PD-1/PD-L1 inhibitor treatment approaches help prolong PFS in breast cancer patients, but have no statistically significant effect on overall survival (OS). Additionally, combination therapy can significantly improve complete response rate (CRR) compared with chemotherapy alone. However, combination therapy was associated with greater rates of adverse events.

• Publisher: Lippincott Williams & Wilkins,Lippincott Williams & Wilkins Ovid Technologies,Department of Burn and Plastic Surgery-Hand Surgery, The Changshu Hospital Affiliated to Soochow University, Changshu, Soochow, Jiangsu 215500, China%Second Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China%College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, Zhejiang 310000, China%Faculty of Basic Medicine, Hangzhou Medical College, Hangzhou, Zhejiang 310000, China%Department of Breast Surgery, Cancer Center, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang 310000, China,Wolters Kluwer
• Subject: B7-H1 Antigen - antagonists & inhibitors / Breast cancer / Breast Neoplasms - drug therapy / Cancer therapies / Chemotherapy / Drug Therapy, Combination / Humans / Immune Checkpoint Inhibitors - therapeutic use / Immunotherapy / Investigations / Ligands / Meta Analysis / Monoclonal antibodies / Programmed Cell Death 1 Receptor - antagonists & inhibitors / Risk assessment