Efficacy and safety of adjuvant capecitabine and pembrolizumab in early-stage triple-negative breast cancer after standard neo-/adjuvant chemotherapy: A meta-analysis of phase III studies.
Wala Ben Kridis, Afef Khanfir
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In 30 seconds
This systematic review and meta-analysis pooled four phase III randomised trials involving 3133 participants with early-stage triple-negative breast cancer, comparing outcomes with adjuvant capecitabine or pembrolizumab after standard chemotherapy. Pembrolizumab was associated with improved overall survival (HR 0.66, 95% CI: 0.64-0.79) and disease-free survival (HR: 0.63, 95% CI: 0.43-0.93). Capecitabine significantly reduced recurrence risk (HR: 0.67, 95% CI: 0.52-0.88), while its pooled overall-survival estimate was less conclusive (HR: 0.75, 95% CI: 0.55-1.03).
Key findings
- Pembrolizumab was associated with improved overall survival: HR 0.66 (95% CI: 0.64-0.79), corresponding to a reported 34% reduction in risk of death.
- Pembrolizumab improved disease-free survival, with HR: 0.63 (95% CI: 0.43-0.93).
- Capecitabine reduced recurrence risk, with HR: 0.67 (95% CI: 0.52-0.88).
- Capecitabine's pooled overall-survival estimate was HR 0.75 (95% CI: 0.55-1.03), with mixed results across studies.
Why it matters
The pooled findings distinguish the reported survival outcomes for two adjuvant approaches in early-stage TNBC: pembrolizumab showed benefit for both overall and disease-free survival, whereas capecitabine's clearer pooled benefit was for disease-free survival. This helps frame the evidence for recurrence and survival outcomes while highlighting that the overall-survival estimate for capecitabine remains uncertain.
What to keep in mind
The analysis pooled only four trials, and capecitabine results varied across studies. The abstract notes that further studies and longer-term survival data are needed.