Clinical Efficacy of Neoadjuvant Camrelizumab Plus Chemotherapy for Triple-Negative Breast Cancer and Tumor Immune Microenvironment Analysis: A Prospective-Retrospective Cohort Study.

Abstract

The impact of immune checkpoint inhibitors combined with neoadjuvant chemotherapy (NAC) on surgical outcomes and immune remodeling remains underexplored. To investigate the efficacy and tumor immune microenvironment (TIME) changes of camrelizumab plus NAC for triple-negative breast cancer (TNBC), we collected TNBC patients receiving neoadjuvant immunochemotherapy (NIC) or NAC from clinical trials and routine practice, and set a series of endpoints, including total pathological complete response (pCR), breast pCR and TIME characteristics. After propensity score matching, the NIC cohort showed significantly higher rates of total pCR, breast pCR, and axillary pCR, and a lower rate of axillary lymph node dissection than the NAC cohort (all <i>p</i> &lt; 0.05). Within the NIC group, patients achieving total pCR (<i>p</i> = 0.012) or breast pCR (<i>p</i> = 0.0078) had superior disease-free survival. Analysis of TIME characteristics indicated that the 7 TIME signatures, including tumor inflammation signature, antigen processing machinery and T cell-related features, could predict pCR response to NIC. The finding suggested that in TNBC, NIC enhances pCR achievement and reduces axillary dissection risk. Elevated TIME profiles of the 7 signatures may predict favorable pCR response to NIC.