Eficacia y seguridad de la adición de Inmunoterapia como tratamiento neoadyuvante en pacientes con cáncer de mama triple negativo en estadio temprano. Una Revisión Sistemática y Metaanálisis

Autores/as

  • Jorge Aliaga-Cajan School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Piura 20001, Perú; Jose Cayetano Heredia EsSalud Hospital III-1, Piura 20002, Perú
  • Edgar Yan-Quiroz School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Virgen De La Puerta High Complexity Hospital Essalud, Trujillo 13013, Perú
  • Erick Vásquez-Jaico School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Virgen De La Puerta High Complexity Hospital Essalud, Trujillo 13013, Perú
  • Hugo Valencia-Mariñas School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo 13006, Perú
  • Gustavo Vásquez-Tirado School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Unidad de Cuidados Intensivos, Hospital Regional Docente de Trujillo, Trujillo 13011, Perú
  • Camila Chu-Nonajulca School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Piura 20001, Perú; Sociedad Científica de Estudiantes de Medicina de UPAO, Piura 20001, Perú
  • Victor Serna-Alarcón School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Piura 20001, Perú; Jose Cayetano Heredia EsSalud Hospital III-1, Piura 20002, Perú https://orcid.org/0000-0002-9803-6217

DOI:

https://doi.org/10.35434/rcmhnaaa.2026.192.2959

Palabras clave:

Cáncer de mama triple negativo, Cáncer de mama temprano, Inmunoterapia, Quimioterapia

Resumen

Introducción: El cáncer de mama constituye mundialmente la neoplasia maligna de mayor frecuencia en el sexo femenino. Las pacientes con diagnóstico de cáncer de mama triple negativo en etapa temprana constituyen un desafío de tratamiento. Recientemente se reportó el beneficio de la adición de la inmunoterapia a la quimioterapia neoadyuvante. Objetivo: Desarrollar una revisión sistemática y metaanálisis para comparar inmunoterapia más quimioterapia con quimioterapia en el tratamiento de pacientes con cáncer de mama triple negativo en etapa temprana. Métodos: Una búsqueda sistemática permitió identificar estudios clínicos aleatorizados para el tratamiento de cáncer de mama triple negativo en etapa temprana. Los desenlaces de interés fueron respuesta patológica completa (RPC),  sobrevida libre de eventos (SLE) y eventos adversos de los que se estimó el odds ratio. Resultados: En relación con la RPC observamos que la inmunoterapia más quimioterapia en las pacientes con cáncer de mama triple negativo en etapa temprana presentaron una respuesta estadísticamente significativa mayor comparada con el control (OR = 1.59 [95% CI : 1.10-2.31]; P=0.35, I² = 8%). La SLE fue mayor en el grupo de inmunoterapia más quimioterapia que en el grupo control, pero estadísticamente no significativa (OR = 1.75 [95% CI: 0.32-9.65]; P=0.49; I² = 0%). Conclusión: Las pacientes con cáncer de mama temprano triple negativo que recibieron Inmunoterapia más quimioterapia presentaron una mejora en los niveles de RPC. Esta intervención no muestra mayores niveles de asociación con eventos adversos grado 3 o más, pero si, con eventos adversos inmunomediados, debiendo prestar especial atención a la función tiroidea.

Descargas

Los datos de descarga aún no están disponibles.

Biografía del autor/a

  • Jorge Aliaga-Cajan, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Piura 20001, Perú; Jose Cayetano Heredia EsSalud Hospital III-1, Piura 20002, Perú
    1. Médico especialista en oncología clínica. Doctor en investigación clínica y traslacional.
  • Edgar Yan-Quiroz, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Virgen De La Puerta High Complexity Hospital Essalud, Trujillo 13013, Perú

    1. Medico-cirujano oncólogo

  • Erick Vásquez-Jaico, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Virgen De La Puerta High Complexity Hospital Essalud, Trujillo 13013, Perú

    1. Médico

  • Hugo Valencia-Mariñas, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo 13006, Perú

    1. Médico

  • Gustavo Vásquez-Tirado, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Trujillo 13008, Perú; Unidad de Cuidados Intensivos, Hospital Regional Docente de Trujillo, Trujillo 13011, Perú

    1. Médico

  • Camila Chu-Nonajulca, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Piura 20001, Perú; Sociedad Científica de Estudiantes de Medicina de UPAO, Piura 20001, Perú

    1. Estudiante

  • Victor Serna-Alarcón, School of Medicine, Faculty of Medicine, Antenor Orrego Private University, Piura 20001, Perú; Jose Cayetano Heredia EsSalud Hospital III-1, Piura 20002, Perú

    1. Doctor en Investigación Clínica y Traslacional  

Referencias

1.Sung H, Ferlay, Siegel RL, Laversanne M, Soerjomataram I., Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin 2021; 71(3): 209-249.

https://doi.org/10.3322/caac.21660

2.IARC – International Agency for Research on Cancer [Internet]. [cited Feb. 13, 2025]. Available at: https://www.gco.iarc.fr/today/en/dataviz

3.Prat A, Parker J, Fan C, Perou C, PAM50 assay and the three-gene model for Identifying the major and clinically relevant molecular subtypes of breast cancer. Breast Cancer Res Treat 2012; 135:301-306.

https://doi.org/10.1007/s10549-012-2143-0

4.Carey L, Dees E, Sawyer L, Gatti L, Moore D, Collichiog F, et al. The triple-negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 2007;13(8):2329-34

https://doi.org/10.1158/1078-0432.CCR-06-1109

5.Zhang X, Ge X, Jiang T, et al. Research progress on inmunotherapy in triple-negative breast cancer (Review). International Journal of Oncology 2022; 61(95): 1-12

https://doi.org/10.3892/ijo.2022.5385

6.Gluz O, Liedtke C, Gottschalk N, Pusztai L, Nitz U and Harbeck N. Triple-negative breast cancer-current status and future directions. Ann Oncol 2009; 20(12): 1913-1927.

https://doi.org/10.1093/annonc/mdp492

7.Millis SZ, Gatalica Z, Winkler J, et al: Predictive biomarker profiling of > 6000 breast cancer patients shows heterogeneity in TNBC, with treatment implications. Clin Breast Cancer 2015; 15(6):473-481.

https://doi.org/10.1016/j.clbc.2015.04.008

8.Liu Y, Zou Y, Ye Y et al. Advances in the Understanding of the Pathogenesis of Triple- Negative Breast Cancer. Cancer Medicine 2024; 13: 1 – 13.

https://doi.org/10.1002/cam4.70410

9.Loi S, Drubay D, Adams S, et al: Tumor-infiltrating lymphocytes and prognosis: A pooled individual patient analysis of early-stage triple-negative breast cancers. J Clin Oncol 2019; 37(7):559-569

https://doi.org/10.1200/JCO.18.01010

10.Mittendorf EA, Philips AV, Meric-Bernstam F, et al: PD-L1 expression in triple-negative breast cancer. Cancer Immunol Res 2014; 2(4):361-370.

https://doi.org/10.1158/2326-6066.CIR-13-0127

11.Barroso-Sousa R, Jain E, Cohen O, et al: Prevalence and mutational determinants of high tumor mutation burden in breast cancer. Ann Oncol 2020; 31(3):387-394.

https://doi.org/10.1016/j.annonc.2019.11.010

12.O'Meara TA, Tolaney SM: Tumor mutational burden as a predictor of immunotherapy response in breast cancer. Oncotarget 2021; 12(5):394-400.

https://doi.org/10.18632/oncotarget.27877

13.Zagami P and Carey A. Triple negative breast cancer: Pitfalls and progress. Breast Cancer 2022; 8(95): 1-10.

https://doi.org/10.1038/s41523-022-00468-0

14.Yang T, Li W, Huang T and Zhou J. Immunotherapy Targeting PD-1/PD-L1 in Early-Stage Triple-Negative Breast Cancer. J Pers Med 2023; 13(526): 1-13

https://doi.org/10.3390/jpm13030526

15.Franzoi MA, Romano E, Piccart M. Immunotherapy for early breast cancer: too soon, too superficial, or just right? Annals of Oncology 2021;32 (3): 323-336

https://doi.org/10.1016/j.annonc.2020.11.022

16.Miyashita H, Satoi S, Cruz C, Malamud S. Neo-adjuvant therapy for triple-negative breast cancer: Insights from a network meta-analysis. Breast J 2020; 00:1-12.

https://doi.org/10.1111/tbj.13978

17.Ying-Yi L. Hong-Fei G, Yanga X et al. Neoadjuvant therapy in triple-negative breast cancer: A systematic review and network meta-analysis. The Breast 2022;66: 126 – 135.

https://doi.org/10.1016/j.breast.2022.08.006

18.Gao X, Zhu Y, Wang P, et al. Addition of immune checkpoint inhibitors to chemotherapy versus chemotherapy alone in patients with triple-negative breast cancer: A systematic review and meta-analysis. Cancer Medicine 2023; 12: 21873-21884

https://doi.org/10.1002/cam4.6760

19.Mittal N, Singh S, Mittal R, Kaushal J, Kaushal V. Immune checkpoint inhibitors as Neoadjuvant therapy in early triple-negative breast cancer: A systematic review and meta-analysis. Journal of Cancer Research and Therapeutics 2022; 18(6): 1754-1765.

https://doi.org/10.4103/jcrt.jcrt_1867_20

20. Zhang M, Song J, Yang H et al. Efficacy and safety of PD-1/PD-L1 inhibitors in triple-negative breast cancer: a systematic review and meta-analysis. Acta Oncologica 2022: 61(9): 1105-1115.

https://doi.org/10.1080/0284186X.2022.2106795

21.Mo S, Wang Yuxian, Wang Yaoling et al. Expanding the PD-L1 Paradigm: A Comprehensive Systematic Review and Meta-Analysis of Scoring Systems and Additional Biomarkers Influencing Immune Checkpoint Inhibitor Outcomes in Breast Cancer. Cancer Control 2024;31: 1–12.

https://doi.org/10.1177/10732748241299074

22.Santa María C, O’Donnell M, Nunes R, et al. Integrating Immunotherapy in Early-Stage Triple-Negative Breast Cancer: Practical Evidence-Based Considerations. Journal of the National Comprehensive Cancer Network 2022; 20(7): 738-744.

https://doi.org/10.6004/jnccn.2022.7025

23.Schmid P, Cortes J, Pusztai L, et al. Pembrolizumab for Early Triple-Negative Breast Cancer. KEYNOTE-522. N Engl J Med 2020; 382(9):810-821.

https://doi.org/10.1056/NEJMoa1910549

24.Nanda R, Liu M, Yau C, et al. Effect of Pembrolizumab plus Neoadyuvant Chemotherapy on Pathologic Complete Response in Women with Early-Stage Breast Cancer. An Analysis of the Ongoing Phase 2 Adaptively Randomized I-SPY2 Trial. JAMA Oncol 2020;6:676-684.

https://doi.org/10.1001/jamaoncol.2019.6650

25.Sharma P, Stecklein S, Yoder R, et al. Clinical and Biomarker Findings of Neoadyuvant Pembrolizumab and Carboplatin plus Docetaxel in Triple-Negative Breast Cancer. NeoPACT Phase 2 Clinical Trial. JAMA Oncol 2024; 10(2): 227-235.

https://doi.org/10.1001/jamaoncol.2023.5033

26.Schmid P, Salgado R, Park Y et al. Pembrolizumab plus chemotherapy as neoadjuvant treatment of high-risk, early-stage triple-negative breast cancer: results from the phase1b open label, multicohort KEYNOTE-173 study. Annals of Oncology 2020; 31(5):569-581.

https://doi.org/10.1016/j.annonc.2020.01.072

27.Ademuyiwa F, Brufsky A, Gao F, et al. A randomized phase 2 study of neoadjuvant carboplatin and paclitaxel with or without atezolizumab in triple negative breast cancer (TNBC)- NCI 10013. Cancer Res 2022;8 (134): 1-11 27

https://doi.org/10.1038/s41523-022-00500-3

28.Mittendorf E, Zhang H, Barrios C, et al. Neoadjuvant atezolizumab in combination with sequential nab-paclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early stage triple-negative breast cancer (IMpassion031): a randomised, double-blind, phase 3 trial. The Lancet 2020; 396:1090 -1100.

https://doi.org/10.1016/S0140-6736(20)31953-X

29.Gianni L, Huang C, Egle D et al. Pathologic complete response (pCR) to neoadjuvant treatment with or without atezolizumab in triple-negative, early high-risk and locally advanced breast cancer: NeoTRIP Michelangelo randomized study. Annals of Oncology 2022;33(5): 534-542.

https://doi.org/10.1016/j.annonc.2022.02.004

30.Loibl S, Untch M, Burchardi N et al. A randomized phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadyuvant therapy in early triple-negative breast cancer: Clinical Results and biomarker analysis of GeparNuevo study. Annals of Oncology 2019;30(8) : 1279-1288.

https://doi.org/10.1093/annonc/mdz158

31.Edge S, Compton C. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-4.

https://doi.org/10.1245/s10434-010-0985-4

32.Loibl S, André F, Bachelot T,et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology 2024;35(2): 159-182.

https://doi.org/10.1016/j.annonc.2023.11.016

33.Cortazar P, Zhang L, Untch M. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 2014;384: 164-172.

https://doi.org/10.1016/S0140-6736(13)62422-8

34.Bagegni N, Davis A, Clifton K. Targeted Treatment for High-Risk Early-Stage Triple-Negative Breast Cancer: Spotlight on Pembrolizumab. Breast Cancer : Targets and Therapy 2022;14:113-123.

https://doi.org/10.2147/BCTT.S293597

35.Bianchini G, Balko J, Mayer I et al. Triple-negative breast cancer: challenges and opportunities of a heterogeneous disease. Nat Rev Clin Oncol 2016;13(11): 674-690.

https://doi.org/10.1038/nrclinonc.2016.66

36.Yang T, Li W, Huang T et al . Immunotherapy Targeting PD-1/PD-L1 in Early-Stage Triple-Negative Breast Cancer J Pers Med 2023;13(526):1-16.

https://doi.org/10.3390/jpm13030526

37.Romero D. Benefit in patients with PD-L1-positive TNBC. Nat. Rev. Clin. Oncol. 2019; 16: 6.

https://doi.org/10.1038/s41571-018-0127-7

38. Denkert C, Von Minckwitz G.; Darb-Esfahani S et al. Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: A pooled analysis of 3771 patients treated with neoadjuvant therapy. Lancet Oncol 2018; 19: 40–50

https://doi.org/10.1016/S1470-2045(17)30904-X

39.Emens, L. Breast Cancer Immunotherapy: Facts and Hopes. Clin. Cancer Res 2018, 24, 511–520

https://doi.org/10.1158/1078-0432.CCR-16-3001

40.Zhang Y.; Zhang Z. The history and advances in cancer immunotherapy: Understanding the characteristics of tumor-infiltrating immune cells and their therapeutic implications. Cell. Mol. Immunol 2020, 17, 807–821.

https://doi.org/10.1038/s41423-020-0488-6

41.Xin Y, Shen G, Zheng Y. Immune checkpoint inhibitors plus neoadjuvant chemotherapy in early triple-negative breast cancer: a systematic review and Meta-analysis. BMC Cáncer 2021; 21(1): 1261.

ttps://doi.org/10.1186/s12885-021-08997-w

42.Sternschuss M, Yerushalmi R, Saleh RR, et al. Efficacy and safety of neoadjuvant immune checkpoint inhibitors in early-stage triple-negative breast cancer: a systematic review and Meta-analysis. J Cancer Res Clin Oncol 2021;147(11):3369–3379.

https://doi.org/10.1007/s00432-021-03591-w

43.Schmid P, Rugo H, Adams S, et al. Atezolizumab plus nab-paclitaxel as first-line treatment for unresectable, locally advanced or metastatic triple-negative breast cancer (IMpassion130): Updated efficacy results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21:44-59.

https://doi.org/10.1016/S1470-2045(19)30689-8

Descargas

Publicado

12-07-2026

Número

Vol. 19 Núm. 2 (2026): Publicación Anticipada

Sección

Artículo Original

Categorías

Licencia

Derechos de autor 2026 Jorge Aliaga-Cajan, Edgar Yan-Quiroz, Erick Vásquez-Jaico, Hugo Valencia-Mariñas, Gustavo Vásquez-Tirado, Camila Chu-Nonajulca, Victor Serna-Alarcón

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.

Cómo citar

1.
Eficacia y seguridad de la adición de Inmunoterapia como tratamiento neoadyuvante en pacientes con cáncer de mama triple negativo en estadio temprano. Una Revisión Sistemática y Metaanálisis. Rev. Cuerpo Med. HNAAA [Internet]. 2026 Jul. 12 [cited 2026 Aug. 17];19(2):e2959. Available from: https://cmhnaaa.org.pe/index.php/rcmhnaaa/article/view/2959

Artículos similares

1-10 de 110

También puede Iniciar una búsqueda de similitud avanzada para este artículo.