Immunotherapy May Enable Safe Axillary De-escalation in Node-Positive TNBC

This registry analysis suggests that adding immune checkpoint inhibitors to neoadjuvant chemotherapy erases the historical survival penalty of omitting full axillary dissection in clinically node-positive triple-negative breast cancer, sharpening the pharmacist's framing of chemo-immunotherapy as a locoregional as well as systemic tool.

pembrolizumabimmune checkpoint inhibitorsneoadjuvant chemotherapytriple-negative breast canceraxillary de-escalationsentinel lymph node biopsyaxillary lymph node dissectionNational Cancer Databaseretrospective cohortsurgical oncology Oncology Pharmacy

Background Information

Chemo-immunotherapy may enable less invasive breast cancer surgeries.

This study examines whether chemo-immunotherapy can safely allow for less invasive axillary surgery in patients with clinically node-positive triple-negative breast cancer. Immune checkpoint inhibitor addition neutralized the negative survival impact of using sentinel lymph node biopsy instead of more extensive surgery, showing similar overall survival rates. Findings suggest that modern chemo-immunotherapy might facilitate less invasive surgeries without compromising survival, warranting further clinical trials. Chemo-immunotherapy may allow for axillary surgery de-escalation in triple-negative breast cancer without affecting survival.

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Authors: Li Z, Qu Z, Pei S, Xian K, Zhang H, Yang X, Zhang L, Zhang JQ, Fayanju OM, Wang J, Fang Y

Citation: Li Z, Qu Z, Pei S, et al. Survival outcomes of axillary de-escalation following neoadjuvant chemo-immunotherapy in clinically node-positive triple-negative breast cancer: a national cancer database study. Frontiers in immunology. 2026;17:1892648. doi:10.3389/fimmu.2026.1892648

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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