Effects of the Combination of Neoadjuvant Immunotherapy with Chemotherapy versus Placebo with Chemotherapy on Pathologic Complete Response in Early Triple-Negative Breast Cancer: A Systematic Review

Hendra Aditama , Dampit Pinaluki — Tue, 16 May 2023 00:00:00 +0000

Introduction: One of the most aggressive forms of breast cancer is triple-negative breast cancer (TNBC). TNBC has a poor prognosis and limited therapeutic options. Therefore, therapeutic intervention is strongly suggested when treatment with the intention of cure is still possible. Chemotherapy and immune checkpoint inhibitors have already been utilized to raise the pathologic complete response (pCR) rates in early-stage TNBC patients.

Objectives: The study aims to assess the efficacy of neoadjuvant immunotherapy in combination with chemotherapy, in the early-stage TNBC, with the primary endpoint of pCR (ypT0/is ypN0).

Methods: The medical term “Immunotherapy”, “Pembrolizumab”, “Atezolizumab”, “Durvalumab”, “Neoadjuvant treatment”, and “Triple-negative breast cancer”, were used in Pubmed and Google Scholar to discover studies of the efficacy of immunotherapy combined with chemotherapy in early-stage TNBC by following the PICO framework up to January 2023. All phase 1, 2, and 3 clinical studies demonstrating safety and efficacy data were included. Two independent reviewers excluded the non-RCTs and other clinical studies irrelevant to the study question. Five remaining studies were reviewed and screened for the inclusion criteria, based on the relevance to the study subject and clinical outcomes.

Results: Based on five studies included in this review, a combination of immunotherapy (pembrolizumab, atezolizumab, or durvalumab) with chemotherapy has shown superior effects of increasing pCR rates, compared to the chemotherapy alone, regardless of PD-L1 status, in early-stage TNBC. Adverse events were not more frequently reported with the immunotherapy compared to placebo.

Conclusions: A combination of neoadjuvant immunotherapy with chemotherapy has revealed superior effects of increasing pCR rates, compared to the chemotherapy alone in early-stage TNBC, irrespective of PD-L1 status, with an acceptable safety profile. However, further studies are needed to explore this issue.

Non-Compliance with the Operating Program: Analyzing the Causes and Consequences: A Case Study

Tue, 23 May 2023 00:00:00 +0000

Background: Surgical scheduling in hospitals is critical to optimize surgical activity and ensure quality of care. Surgical scheduling can be affected by a variety of factors leading to cancellation or delay of surgical procedures, which can result in financial and personal hardship for patients and their families. The study aimed of to identify the incidence and causes of non-adherence to the surgical schedule in the operating room of the Mohammed V Military Teaching Hospital in Rabat, Morocco.

Methods: We analyzed the medical records of patients admitted for surgery over a 12-month period. Data collected included the number of scheduled, canceled, and added surgeries, epidemiological data of the patients, pathologies involved, reasons for cancellation and addition, and patient outcomes.

Results: We analyzed a total of 3023 scheduled surgeries, of which 215 (7.11%) were cancelled and 167 (5.6%) were added. Neurosurgery was the most frequently cancelled surgical specialty. The most common reasons for cancellation were infection, decompensation of a chronic pathology, and lack of availability of the operating room. Orthopedic surgery was also the most affected specialty in the added surgeries, mostly due to surgical emergencies. Our analysis of patient demographics revealed that the average age of cancelled surgery patients was 52.16 ± 14.6 years, with a male predominance of 63.25%. Based on ASA classification, 57.6% of patients were classified as ASA I, 33.48% as ASA II, and only 8.84% as ASA III. Medical and anesthesia-related causes accounted for 30 cancellations, with anesthesia contraindications (13.3%) and abnormal test results (40%) being the most common reasons. Surgery-related causes accounted for 22 cancellations, with non-availability of the surgeon (50%) being the most frequent reason. Patient-related causes accounted for 55 cancellations, with non-compliance with pre-anesthesia treatment (58.18%) being the most common reason. Organizational causes accounted for 108 cancellations, with equipment failure (40.7%) being the most frequent reason.

Conclusion: This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of health care delivered by hospitals.

Asian Journal of Research in Surgery

Effects of the Combination of Neoadjuvant Immunotherapy with Chemotherapy versus Placebo with Chemotherapy on Pathologic Complete Response in Early Triple-Negative Breast Cancer: A Systematic Review

Non-Compliance with the Operating Program: Analyzing the Causes and Consequences: A Case Study