Qi Yingjie, Yan Xin, Wang Chao, Cao Hui, Liu Guangxuan
Department of Pharmacy, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China.
Front Pharmacol. 2022 Dec 2;13:1004821. doi: 10.3389/fphar.2022.1004821. eCollection 2022.
Immune checkpoint inhibitors (ICIs) have been an emerging treatment strategy for advanced triple-negative breast cancer (TNBC). Some studies have shown that high expression of programmed death-ligand 1 (PD-L1) can achieve a better response of clinical efficacy. However, the efficacy of ICIs in advanced TNBC remains controversial. In this meta-analysis, we evaluated the correlation of PD-L1 expression with the efficacy of ICIs in patients with advanced TNBC. We conducted a systematic search using four databases until March 2022 to obtain eligible randomized controlled trials (RCTs). The quality of the studies was assessed by the Cochrane risk of bias tool. Hazard ratio (HR) was extracted to evaluate the relationship between PD-L1 expression and progression-free survival (PFS) or overall survival (OS) in patients with advanced TNBC. Five randomized controlled clinical trials (RCTs) with 3104 patients were included in this meta-analysis. The results demonstrated that ICIs could significantly improve the OS (HR 0.77, 95% CI 0.60-0.98, = 0.03) in PD-L1 positive TNBC group. In the subgroup analysis, longer OS was observed (HR: 0.70, 95% CI: 0.60-0.82, = 0.00001) in PD-L1 positive TNBC patients receiving ICIs alone or ICIs combined with nab-paclitaxel. In terms of PFS, PFS was significantly improved (HR: 0.68, 95% CI: 0.58-0.79, < 0.00001) in PD-L1 positive patients receiving first-line ICIs and chemotherapy compared to those with ICIs alone. No significant improvement was observed for OS or PFS in PD-L1 negative group. Our study indicated significant improvement for OS in advanced TNBC with ICIs therapy in the PD-L1 positive status, and ICIs alone or ICIs combined with nab-paclitaxel might be a excellent choice in terms of OS. Although PFS has no significant benefit in PD-L1 positive patients, the subgroup analysis showed that ICIs combined with chemotherapy could achieve the PFS benefit in the first-line treatment. However, further clinical studies are needed to validate our conclusions due to limited relevant research.
免疫检查点抑制剂（ICIs）已成为晚期三阴性乳腺癌（TNBC）的一种新兴治疗策略。一些研究表明，程序性死亡配体1（PD-L1）的高表达可使临床疗效获得更好的反应。然而，ICIs在晚期TNBC中的疗效仍存在争议。在这项荟萃分析中，我们评估了PD-L1表达与ICIs在晚期TNBC患者中的疗效之间的相关性。我们使用四个数据库进行了系统检索，直至2022年3月，以获取符合条件的随机对照试验（RCTs）。研究质量通过Cochrane偏倚风险工具进行评估。提取风险比（HR）以评估PD-L1表达与晚期TNBC患者无进展生存期（PFS）或总生存期（OS）之间的关系。本荟萃分析纳入了五项随机对照临床试验（RCTs），共3104例患者。结果表明ICIs可显著改善PD-L1阳性TNBC组的OS（HR 0.77，95%CI 0.60 - 0.98，P = 0.03）。在亚组分析中，单独接受ICIs或ICIs联合白蛋白结合型紫杉醇的PD-L1阳性TNBC患者观察到更长的OS（HR：0.70，95%CI：0.60 - 0.82，P = 0.00001）。在PFS方面，与单独接受ICIs的患者相比，接受一线ICIs和化疗的PD-L1阳性患者的PFS显著改善（HR：0.68，95%CI：0.58 - 0.79，P < 0.00001）。在PD-L1阴性组中，未观察到OS或PFS有显著改善。我们的研究表明，ICIs治疗在PD-L1阳性状态的晚期TNBC中可显著改善OS，就OS而言，单独使用ICIs或ICIs联合白蛋白结合型紫杉醇可能是一个不错的选择。虽然PD-L1阳性患者的PFS无显著获益，但亚组分析表明，ICIs联合化疗在一线治疗中可实现PFS获益。然而，由于相关研究有限，需要进一步的临床研究来验证我们的结论。
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