# Predictors of Pathologic Complete Response with Neoadjuvant Chemo-Immunotherapy in Early-Stage Triple-Negative Breast Cancer

**Autores:** Lauren M Perry, Varadan Sevilimedu, Natalia Polidorio et al.
**Revista:** Ann Surg Oncol (2025)
**PMID:** 40025324 | **PMCID:** PMC12055475
**DOI:** [10.1245/s10434-025-17081-7](https://doi.org/10.1245/s10434-025-17081-7)
**Fuente:** PubMed Central (open access full-text)

## Relevancia
Análisis retrospectivo (n=283) en TNBC tratado con quimio-inmunoterapia (pembrolizumab + QT) neoadyuvante. Tasa de pCR global 57%, pCR axilar 67% entre cN+. Identifica edad joven, histología ductal, unifocalidad, IMC normal y ausencia de IVL como predictores. Relevante para entender qué pacientes alcanzarán ypN0.

## Abstract
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).

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.

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.

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.

## Texto completo
Texto completo disponible en PMC: [PMC12055475](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055475/). El artículo analiza predictores clínico-patológicos de pCR axilar y mamaria en pacientes con TNBC tratadas con QT + pembrolizumab. Aporta tasas de pCR axilar del 67% en cN+ biopsy-proven, un dato cuantitativo importante para informar la toma de decisiones sobre la magnitud de la cirugía axilar a planificar.

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*Datos de PubMed. Citar: doi 10.1245/s10434-025-17081-7*
