AI Article Synopsis

  • - The study aimed to understand MRI imaging patterns in breast cancer patients undergoing neoadjuvant immunotherapy, particularly focusing on responses to various combinations of chemotherapy and immunotherapy in the I-SPY2 clinical trial.
  • - Out of 43 patients analyzed, 44.4% receiving the chemo-immunotherapy experienced increased lymphadenopathy in the first 12 weeks, significantly higher compared to just 6.3% in the control group, with most cases linked to the SD-101 and pembrolizumab treatment.
  • - Despite observing increased lymphadenopathy in some patients, this was not associated with a higher incidence of positive lymph nodes at surgery, even as breast tumor sizes decreased over time.

Article Abstract

Purpose: Establishing breast MRI imaging patterns associated with neoadjuvant immunotherapy is needed to monitor response. We analyzed serial breast MRIs in patients receiving neoadjuvant chemo-immunotherapy on the I-SPY2 clinical trial.

Methods: Patients with stage 2-3 HER2-negative breast cancer were randomized to weekly paclitaxel (control), weekly paclitaxel and pembrolizumab, or weekly paclitaxel, pembrolizumab and intra-tumoral injection of SD-101, a TLR9 agonist. All patients received AC. Regional lymph nodes were retrospectively evaluated on breast MRI at baseline, 3, 12 and 20 weeks by a single blinded radiologist. MRIs were assessed for development of new regional lymphadenopathy, or increase in the longest diameter or cortical thickness of the largest abnormal regional lymph node.

Results: Between 12/2015 and 4/2021, a total of 43 patients enrolled in the control (n = 16) and paclitaxel + pembrolizumab ± SD-101 (n = 27) arms. 12 of 27 patients (44.4%) receiving chemo-immunotherapy experienced increased lymphadenopathy within the first 12 weeks compared to 1 of 16 patients (6.3%) in the control group (p = 0.014). Most patients with increased lymphadenopathy were in the SD101/pembro arm (n = 10, p = 0.002). Increased lymphadenopathy was observed despite concomitant decrease in breast tumor size at all time points. 11 of 12 patients with increased lymphadenopathy had pathologically negative nodes at surgery. There was no association between lymphadenopathy and lower residual cancer burden or immune-related toxicity.

Conclusions: The combination of neoadjuvant paclitaxel and pembrolizumab ± SD101 intratumoral injection was associated with early increases in regional lymphadenopathy on MRI despite decreased breast tumor size. Increased lymphadenopathy was not associated with node positive disease at surgery.

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Source
http://dx.doi.org/10.1007/s10549-024-07481-wDOI Listing

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