Impact of neoadjuvant chemoimmunotherapy on surgical outcomes and time to radiation in triple-negative breast cancer Journal Article

   


Authors: Myers, S. P.; Sevilimedu, V.; Jones, V. M.; Abuhadra, N.; Montagna, G.; Plitas, G.; Morrow, M.; Downs-Canner, S. M.
Article Title: Impact of neoadjuvant chemoimmunotherapy on surgical outcomes and time to radiation in triple-negative breast cancer
Abstract: Background: We examined the association between immunotherapy-containing and standard chemotherapy regimens with treatment delays and postoperative complications in stage II–III triple-negative breast cancer. The effect of immune-related adverse events (irAEs) was compared. Patients and Methods: We compared 139 women treated with neoadjuvant pembrolizumab plus chemotherapy (KEYNOTE-522 regimen) from August 2021 to September 2022 with 287 consecutive patients who received neoadjuvant chemotherapy alone prior to July 2021 and underwent surgery. Baseline characteristics, time to treatments, and surgical complications were compared using two-sample non-parametric tests. Linear regression evaluated association of irAEs with time to surgery and radiation. Logistic regression identified factors associated with surgical complications. Results: Age, body mass index, race, American Society of Anesthesiologists (ASA) class, and mastectomy rates were similar among cohorts. No clinically relevant difference in time from end of neoadjuvant treatment to surgery was observed [KEYNOTE-522: median 32 (IQR 27, 43) days; non-KEYNOTE-522: median 31 (IQR 26, 37) days; P = 0.048]. Time to radiation did not differ (P = 0.7). A total of 26 patients (9%; non-KEYNOTE-522) versus 11 (8%; KEYNOTE-522) experienced postoperative complications (P = 0.6). In the KEYNOTE-522 cohort, 59 (43%) of 137 patients experienced 82 irAEs; 40 (68%) required treatment. Older age (P = 0.018) and ASA class 4 (P = 0.007) were associated with delays to surgery after adjusting for clinical factors. Experiencing ≥ 1 irAE was associated with delay to radiation (P = 0.029). IrAEs were not associated with surgical complications (P = 0.4). Conclusions: We observed no clinically meaningful difference between times to surgery/adjuvant radiation or postoperative complications and type of preoperative chemotherapy. IrAEs were associated with delay to adjuvant radiation but not with postoperative complications or delay to surgery. © Society of Surgical Oncology 2024.
Keywords: adult; controlled study; aged; middle aged; antibiotic agent; survival rate; retrospective studies; major clinical study; hepatitis; doxorubicin; unspecified side effect; paclitaxel; cancer patient; neoadjuvant therapy; radiotherapy, adjuvant; follow up; follow-up studies; antineoplastic agent; mastectomy; antineoplastic combined chemotherapy protocols; cohort analysis; cyclophosphamide; immunoglobulin; steroid; pathology; retrospective study; monoclonal antibody; pneumonia; postoperative complication; postoperative complications; body mass; immunotherapy; ischemia; arthritis; diabetes mellitus; surgical infection; insulin; colitis; dermatitis; eye disease; neoadjuvant chemotherapy; hyperthyroidism; hypothyroidism; neurological complication; adjuvant radiotherapy; atenolol; calcium channel blocking agent; therapy; adrenal insufficiency; levothyroxine sodium; triple negative breast cancer; triple-negative breast cancer; myositis; clinical outcome; hypertransaminasemia; nephritis; surgical outcomes; immune checkpoint blockade; chemoimmunotherapy; antibodies, monoclonal, humanized; time to treatment; time-to-treatment; humans; prognosis; human; female; article; pembrolizumab; triple negative breast neoplasms; breast radiotherapy; american society of anaesthesiologists score; hyperglycemic agent
Journal Title: Annals of Surgical Oncology
Volume: 31
Issue: 8
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2024-08-01
Start Page: 5180
End Page: 5188
Language: English
DOI: 10.1245/s10434-024-15359-w
PUBMED: 38767803
PROVIDER: scopus
PMCID: PMC11918259
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85193746895&doi=10.1245%2fs10434-024-15359-w&partnerID=40&md5=187eb949b940cb739061c27ec0ef5f45
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Monica Morrow
    772 Morrow
  2. George Plitas
    107 Plitas
  3. Stephanie Michelle Downs-Canner
    37 Downs-Canner
  4. Giacomo Montagna
    100 Montagna
  5. Srinivasa Vardan Sevilimedu Veeravalli
    202 Sevilimedu Veeravalli
  6. Nour Abuhadra
    23 Abuhadra
  7. Sara Poorfarahani Myers
    18 Myers
  8. Veronica Morgan Jones
    7 Jones
Related MSK Work