Predictors of pathologic complete response with neoadjuvant chemo-immunotherapy in early-stage triple-negative breast cancer Journal Article
| Authors: | Perry, L. M.; Sevilimedu, V.; Polidorio, N.; Abuhadra, N.; Morrow, M.; Plitas, G.; Downs-Canner, S. |
| Article Title: | Predictors of pathologic complete response with neoadjuvant chemo-immunotherapy in early-stage triple-negative breast cancer |
| Abstract: | Background: The combination of pembrolizumab with neoadjuvant chemotherapy (NAC) for triple-negative breast cancer (TNBC) improves pathologic complete response (pCR) rates and event-free survival. Yet it is unclear which patients benefit most from the addition of immunotherapy. This study aims to identify predictive factors for pCR in patients with TNBC receiving chemo-immunotherapy (chemo-IO). Patients and Methods: This single-institution retrospective analysis included 283 consecutive patients with TNBC treated with neoadjuvant chemo-IO from 1 June 2021 to 20 January 2023. The primary outcome was overall pCR; secondary outcomes were breast pCR and nodal pCR. Univariate and multivariable logistic regression models assessed for characteristics associated with overall, breast, or nodal pCR. Results: Most patients presented with cT2 (71%) cN0 (54%) disease. The overall pCR rate was 57%, breast pCR was 58%, and axillary pCR was 67% among biopsy-proven cN+ patients. Race, pathogenic BRCA mutations, backbone chemotherapy regimen, immune-related adverse events, and disruptions in immunotherapy were not associated with pCR. Univariate associations with overall pCR were younger age (p = 0.04), lower clinical T stage (p = 0.01), ductal histology (p < 0.001), poor differentiation (p < 0.001), and unifocality (p < 0.001). Breast and axillary pCR had similar associations. Nodal pCR also had univariate associations with normal body mass index (BMI) (p = 0.04) and absence of lymphovascular invasion (LVI) (p = 0.04). On multivariable analyses, ductal histology and unifocality remained independently associated with overall and breast pCR. Conclusions: This analysis showed few clinical variables to be independently associated with pCR after neoadjuvant chemo-IO for TNBC. Thus, predicting chemo-IO response to personalize treatment and minimize morbidity may instead lie in ongoing basic and translational research to assess for useful biomarkers. © Society of Surgical Oncology 2025. |
| Keywords: | adult; cancer chemotherapy; event free survival; human tissue; aged; middle aged; survival rate; retrospective studies; major clinical study; doxorubicin; cancer combination chemotherapy; paclitaxel; neoadjuvant therapy; cancer staging; follow up; follow-up studies; antineoplastic agent; neoplasm staging; biomarkers; carboplatin; cancer immunotherapy; breast cancer; antineoplastic combined chemotherapy protocols; cyclophosphamide; cell differentiation; pathology; retrospective study; monoclonal antibody; body mass; immunotherapy; early cancer; neoadjuvant chemotherapy; drug therapy; carcinoma, ductal, breast; pathological complete response; pathologic complete response; triple negative breast cancer; triple-negative breast cancer; chemoimmunotherapy; antibodies, monoclonal, humanized; lymph vessel metastasis; humans; prognosis; human; female; article; pembrolizumab; triple negative breast neoplasms; breast ductal carcinoma; regression model |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 32 |
| Issue: | 6 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2025-06-01 |
| Start Page: | 3991 |
| End Page: | 4001 |
| Language: | English |
| DOI: | 10.1245/s10434-025-17081-7 |
| PUBMED: | 40175856 |
| PROVIDER: | scopus |
| PMCID: | PMC12055475 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Stephanie Downs‑Canner -- Source: Scopus |
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