Reconstructive conundrums in the era of pembrolizumab treatment for breast cancer: A case series review.

Abstract

Pembrolizumab, commercially known as Keytruda, is a humanized monoclonal antibody targeting the programmed cell death protein 1 (PD-1). Its popularity increased after the KEYNOTE-522 trial demonstrated a statistically significant increase in pathologic complete response compared to placebo in early-stage triple-negative breast cancer patients. This led to global regulatory approvals and a subsequent surge in clinical utilization. Despite the positive outcomes in clinical trials, there is a paucity of information concerning its influence on perioperative and postoperative outcomes, particularly during breast reconstruction. This manuscript offers a concise review of adverse events linked to pembrolizumab and similar immunotherapies. We detail a case series of five patients post-pembrolizumab treatment who underwent breast reconstruction and encountered unforeseen complications, such as thyroid dysregulation, cardiac failure, and epidermolysis. Given the increased use of immunotherapies in breast cancer care, understanding the impact of these adverse effects on surgical outcomes is crucial for optimizing patient care in breast cancer reconstruction.