ABSTRACT
BACKGROUND@#As the efficacy of programmed cell death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors combined with chemotherapy in curing breast cancer is still controversial, this meta-analysis compares the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy and chemotherapy alone in the treatment of breast cancer, which provides guidance for the clinical treatment.@*METHODS@#Relevant studies published as of April 2022 in the various databases including EMBASE, PubMed, and Cochrane Library were selected. Randomized controlled trials (RCTs) in which control patients underwent chemotherapy alone and experimental group patients underwent combination chemotherapy and PD-1/PD-L1 inhibitor treatment were included in this investigation. Investigations without complete information, researches from which information could not be extracted, duplicate articles, animal studies, review articles, and systematic reviews were excluded. STATA 15.1 was employed for all statistical analyses.@*RESULTS@#In total, eight eligible studies were identified, revealing that combination chemotherapy and PD-1/PD-L1 inhibitor treatment was linked to significant increases in progression-free survival (PFS) relative to chemotherapy alone (hazard ratio [HR] = 0.83, 95% confidence interval [CI]: 0.70-0.99, P = 0.032) but not overall survival (HR = 0.92, 95% CI: 0.80-1.06, P = 0.273). Pooled adverse event rates were also increased within the group of combination treatment relative to the chemotherapy group (risk ratio [RR] = 1.08, 95% CI: 1.03-1.14, P = 0.002). Specifically, nausea rates were lesser within the group of combination treatment relative to the group of chemotherapy (RR = 0.48, 95% CI: 0.25-0.92, P = 0.026). Subgroup analyses indicated that the PFS of patients who underwent combination atezolizumab or pembrolizumab and chemotherapy treatment were substantially longer than those of patients who underwent chemotherapy alone (HR = 0.79, 95% CI: 0.69-0.89, P ≤0.001; HR = 0.79, 95% CI: 0.67-0.92, P = 0.002).@*CONCLUSIONS@#The pooled results suggest that combination chemotherapy and PD-1/PD-L1 inhibitor treatment approaches help prolong PFS in breast cancer patients, but have no statistically significant effect on overall survival (OS). Additionally, combination therapy can significantly improve complete response rate (CRR) compared with chemotherapy alone. However, combination therapy was associated with greater rates of adverse events.
Subject(s)
Humans , B7-H1 Antigen/antagonists & inhibitors , Drug Therapy, Combination , Immune Checkpoint Inhibitors/therapeutic use , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Breast Neoplasms/drug therapyABSTRACT
The study on susceptibility genes play an important role in early diagnosis and prevention for the individuals with family history of breast carcinoma,elucidation of pathologic mechanism of sporadic breast carcinoma,early diagnosis and adjudging prognosis,research on drug sensitivity,differential diagnosis of benign and malignant disease,etc.Two major susceptibility genes for breast cancer,BRCA1 and BRCA2,are identified,respectively.Other tumor susceptibility genes such as TP53 are known to increase breast cancer risk of BRCA1 and BRCA2.
ABSTRACT
Objective To investigate the feasibility and complications of the transcranial approach for resection of tumors that involve the anterior skull base, orbit and paranasal sinuses. Methods Nine cases of tumors involving the anterior skull base, orbit and paranasal sinuses, which were resected by transcranial approach alone in our hospital from July 2000 to April 2001, were retrospectively analyzed. All patients had the lesion of the anterior skull base and orbit, and 5 cases had additional paranasal sinuses involvement. Results The tumors in all patients were removed completely. Complications occurred in three cases, including one case of cerebrospinal fluid leaking and two cases of blepharoptosis. One died of tumor recurrence one year after operation. Eight were tumor-free survival during the follow-up period of 20～29 months. Conclusion The transcranial approach can completely remove the tumors widely invading the anterior skull base, orbit and paranasal sinuses. Separation of the periosteum of the orbital roof can cause blepharoptosis, which leads to failure of cosmetics. Extending approach must be avoided if it is possible. The reconstruction of the skull base with pedicle pericranial flap may be the key factor to reduce complications.