Dr. Silky Kumari

Triple-negative breast cancer (TNBC) represents approximately 15–20% of all breast cancers and is characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. TNBC is associated with aggressive clinical behavior , higher rates of visceral metastasis, earlier recurrence, and poorer overall prognosis compared to other breast cancer subtypes. Cytotoxic chemotherapy has historically remained the mainstay of systemic treatment. Among available agents, platinum compounds such as carboplatin and cisplatin have demonstrated particular activity because TNBC frequently exhibits defects in homologous recombination DNA repair pathways, including BRCA1/2 dysfunction. In recent years, immune checkpoint inhibitors against programmed death-1 (PD-1) or programmed death-ligand 1 (PD-L1) have emerged as promising therapeutic strategies. Combining immunotherapy with platinum-based chemotherapy may enhance antitumor immunity and improve outcomes. Objective To conduct a systematic review of existing evidence that contrasts the use of platinum combined with immunotherapy against platinum alone in individuals with early-stage and metastatic TNBC, with an emphasis on evaluating efficacy, survival rates, pathological complete response, and safety. Results Significant trials such as KEYNOTE-355, KEYNOTE-522, IMpassion130, IMpassion031, GeparNuevo, NeoTRIPaPDL1, along with various pooled analyses, have shown enhanced pathological complete response (pCR), progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) in specific TNBC groups receiving platinum combined with immunotherapy, as opposed to chemotherapy alone. The advantages were particularly evident in PD-L1-positive metastatic TNBC and early-stage II–III TNBC. Nonetheless, the incidence of immune-related adverse events was higher in the arms receiving combination therapy. Conclusion Conclusion present data indicate that combining platinum with immunotherapy offers a more effective treatment approach than using platinum by itself for carefully chosen patients with TNBC. It remains crucial to select patients based on biomarkers and to manage toxicity effectively.