Addition of immune checkpoint inhibitors to chemotherapy versus chemotherapy alone in first-line metastatic triple-negative breast cancer: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature (3 essais randomisés, 2 400 patientes), cette méta-analyse évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité de l'ajout d'inhibiteurs de points de contrôle immunitaire à une chimiothérapie de première ligne chez des patientes atteintes d'un cancer du sein triple négatif de stade métastatique
Introduction : The addition of immune checkpoint inhibitors (ICI) to chemotherapy (CT) has been one of the main clinical research endeavors over the last few years in patients with metastatictriple-negative breast cancer (TNBC). Recent randomized controlled trials (RCTs) havepresented heterogeneous results that have elicited discussion in the oncology community.Here we conducted a systematic review and meta-analysis to evaluate this strategy. Material and methods : A systematic literature review was conducted to identify RCTs that evaluated the combinationof ICI plus CT versus CT alone in untreated metastatic TNBC. Random effects modelswere used to estimate pooled hazard ratios (HR) and odds ratios with 95% confidenceintervals (95%CI). Results : A total of three RCTs including 2,400 patients with TNBC met the eligibility criteria. Patients with PD-L1-positive tumors had a significantly better PFS with the additionof ICI (HR=0.67; 95%CI: 0.58–0.79) and a trend towards better OS (HR=0.79; 95%CI:0.60–1.03), while no benefit was observed in patients with PD-L1-negative tumors.In the PD-L1-positive subgroup, no relevant differences were found according to taxaneagent used, ECOG performance status or number of metastatic sites. However, CT naïvepatients obtained a larger benefit with ICI (PFS HR=0.53) than patients previouslytreated with CT in neoadjuvant/adjuvant setting (PFS HR=0.81). The most frequent immune-relatedadverse events in patients receiving ICI were hypothyroidism (16%) and hyperthyroidism(4.9%). Conclusions : ICI plus CT improves PFS and OS in PD-L1-positive population. A greater benefit inCT naïve patients was observed for the PD-L1-positive population while no difference was observed between taxane regimes used.