{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:32:26Z","timestamp":1788478346074,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Pegylated liposomal doxorubicin (PLD), an improved formulation of doxorubicin, offers potential advantages in targeting and reduced systemic toxicity compared to conventional anthracyclines like epirubicin. This study aimed to compare the efficacy and safety of PLD followed by paclitaxel versus epirubicin followed by paclitaxel as postoperative adjuvant therapy for triple-negative breast cancer (TNBC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 1,036 patients with TNBC who received postoperative adjuvant chemotherapy with either PLD sequential paclitaxel or epirubicin sequential paclitaxel were enrolled. The primary endpoint was disease-free survival (DFS). Adverse events were systematically documented. Multivariate Cox regression identified prognostic factors, and a predictive nomogram was developed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At median follow-up, 1-, 3-, and 5-year DFS rates were 93.39%, 84.04%, and 84.04% for the PLD group versus 93.58%, 82.38%, and 81.73% for the epirubicin group (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      = 0.58). Postoperative N stage, stromal tumor-infiltrating lymphocyte (sTIL) expression, and Ki67 expression were independent predictors of DFS. The prognostic model achieved C-indices of 0.874 (training set) and 0.853 (validation set). The PLD regimen was associated with a significantly lower incidence of most adverse events; however, nausea, mucositis, and hand-foot syndrome were more frequent in the PLD group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In adjuvant therapy for TNBC, PLD sequential paclitaxel demonstrated comparable efficacy to epirubicin sequential paclitaxel. However, PLD exhibited a distinct and generally more favorable safety profile, except for specific toxicities such as hand-foot syndrome and mucositis. The developed nomogram may aid in individualized prognosis prediction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1690888","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:47:43Z","timestamp":1770187663000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Adjuvant pegylated liposomal doxorubicin versus epirubicin sequential paclitaxel in triple-negative breast cancer: comparable efficacy with a distinct safety profile"],"prefix":"10.3389","volume":"17","author":[{"given":"Shuanglong","family":"Cai","sequence":"first","affiliation":[{"name":"Comprehensive Breast Health Center, Department of Thyroid and Breast Surgery, The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People\u2019s Hospital","place":["Lishui, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohong","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuquan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fuzhou University Affiliated Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Fuzhou University Affiliated Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongdan","family":"Chen","sequence":"additional","affiliation":[{"name":"First Department of Cadre Clinic, Fuzhou University Affiliated Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Ma","sequence":"additional","affiliation":[{"name":"The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaogeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, Fuzhou University Affiliated Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Shi","sequence":"additional","affiliation":[{"name":"Comprehensive Breast Health Center, Department of Thyroid and Breast Surgery, The Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People\u2019s Hospital","place":["Lishui, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1002\/cncr.22381","article-title":"Prognostic markers in triple-negative breast cancer","author":"Rakha","year":"2007","journal-title":"Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-06-3045","article-title":"Triple-negative breast cancer: clinical features and patterns of recurrence","volume":"13","author":"Dent","year":"2007","journal-title":"Clin Cancer Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-06-1109","article-title":"The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes","volume":"13","author":"Carey","year":"2007","journal-title":"Clin Cancer Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103153441101","article-title":"Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2","volume":"344","author":"Slamon","year":"2001","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66544-0","article-title":"Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials","volume":"365","year":"2005","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"eadf1147","DOI":"10.1126\/scitranslmed.adf1147","article-title":"Beta-blockade enhances anthracycline control of metastasis in triple-negative breast cancer","volume":"15","author":"Chang","year":"2023","journal-title":"Sci Transl Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/jama.2018.19323","article-title":"Breast cancer treatment: a review","volume":"321","author":"Waks","year":"2019","journal-title":"JAMA"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1126\/science.2470152","article-title":"Studies of the HER-2\/neu proto-oncogene in human breast and ovarian cancer","volume":"244","author":"Slamon","year":"1989","journal-title":"Science"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11407","article-title":"Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials","volume":"97","author":"Swain","year":"2003","journal-title":"Cancer"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2165\/11207510-000000000-00000","article-title":"Pegylated liposomal doxorubicin: a review of its use in metastatic breast cancer, ovarian cancer, multiple myeloma and AIDS-related Kaposi\u2019s sarcoma","volume":"71","author":"Duggan","year":"2011","journal-title":"Drugs"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200342050-00002","article-title":"Pharmacokinetics of pegylated liposomal Doxorubicin: review of animal and human studies","volume":"42","author":"Gabizon","year":"2003","journal-title":"Clin Pharmacokinet"},{"key":"B12","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.drup.2016.10.003","article-title":"New insights and evolving role of pegylated liposomal doxorubicin in cancer therapy","volume":"29","author":"Gabizon","year":"2016","journal-title":"Drug Resist Update"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2024.0035","article-title":"Breast cancer, version 3.2024, NCCN clinical practice guidelines in oncology","volume":"22","author":"Gradishar","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"key":"B14","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/ajco.12771","article-title":"Efficacy and toxicity of pegylated liposomal doxorubicin-based chemotherapy in early-stage breast cancer: a multicenter retrospective case-control study","volume":"14","author":"Yang","year":"2018","journal-title":"Asia Pac J Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.10.015","article-title":"Intense dose-dense epirubicin, paclitaxel, cyclophosphamide versus weekly paclitaxel, liposomal doxorubicin (plus carboplatin in triple-negative breast cancer) for neoadjuvant treatment of high-risk early breast cancer (GeparOcto-GBG 84): A randomised phase III trial","volume":"106","author":"Schneeweiss","year":"2019","journal-title":"Eur J Cancer"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/his.14091","article-title":"The 2019 World Health Organization classification of tumours of the breast","volume":"77","author":"Tan","year":"2020","journal-title":"Histopathology"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6486-6","article-title":"Eighth edition of the AJCC cancer staging manual: breast cancer","volume":"25","author":"Giuliano","year":"2018","journal-title":"Ann Surg Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.25.6529","article-title":"American Society of Clinical Oncology\/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer","volume":"28","author":"Hammond ME","year":"2010","journal-title":"J Clin Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"18","DOI":"10.5858\/2007-131-18-ASOCCO","article-title":"American Society of Clinical Oncology\/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer","volume":"131","author":"Wolff","year":"2007","journal-title":"Arch Pathol Lab Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603756","article-title":"Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients","volume":"96","author":"Azambuja","year":"2007","journal-title":"Br J Cancer"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.0595","article-title":"Comparison of breast cancer molecular features and survival by african and european ancestry in the cancer genome atlas","volume":"3","author":"Huo","year":"2017","journal-title":"JAMA Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.21.2492","article-title":"Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study","volume":"295","author":"Carey","year":"","journal-title":"JAMA"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.2147\/OTT.S162003","article-title":"Comparable efficacy and less toxicity of pegylated liposomal doxorubicin versus epirubicin for neoadjuvant chemotherapy of breast cancer: a case-control study","volume":"11","author":"Dong","year":"2018","journal-title":"Onco Targets Ther"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1186\/s12885-021-09050-6","article-title":"Effectiveness and safety of pegylated liposomal doxorubicin versus epirubicin as neoadjuvant or adjuvant chemotherapy for breast cancer: a real-world study","volume":"21","author":"Zhang","year":"2021","journal-title":"BMC Cancer"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62422-8","article-title":"Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis","volume":"384","author":"Cortazar","year":"2014","journal-title":"Lancet"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00435","article-title":"Standardized definitions for efficacy end points in neoadjuvant breast cancer clinical trials: neoSTEEP","volume":"41","author":"Litton","year":"2023","journal-title":"J Clin Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1093\/annonc\/mdx049","article-title":"A phase 2, randomized, double-blind, placebo- controlled study of chemo-immunotherapy combination using motolimod with pegylated liposomal doxorubicin in recurrent or persistent ovarian cancer: a Gynecologic Oncology Group partners study","volume":"28","author":"Monk","year":"2017","journal-title":"Ann Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1996.14.8.2353","article-title":"Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi\u2019s sarcoma","volume":"14","author":"Gill","year":"1996","journal-title":"J Clin Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.07.031","article-title":"Comparison of cardiac events associated with liposomal doxorubicin, epirubicin and doxorubicin in breast cancer: a Bayesian network meta-analysis","volume":"51","author":"Yamaguchi","year":"2015","journal-title":"Eur J Cancer"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdh097","article-title":"Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX\/Doxil) versus conventional doxorubicin for first-line treatment of metastatic breast cancer","volume":"15","author":"R O\u2019Brien","year":"2004","journal-title":"Ann Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.3056","article-title":"Tumor-infiltrating lymphocytes in triple-negative breast cancer","volume":"331","author":"Leon-Ferre","year":"2024","journal-title":"JAMA"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.1917","article-title":"Tumor-infiltrating lymphocytes in patients with stage I triple-negative breast cancer untreated with chemotherapy","volume":"10","author":"Geurts VC","year":"2024","journal-title":"JAMA Oncol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.23.7370","article-title":"Tumor-associated lymphocytes as an independent predictor of response to neoadjuvant chemotherapy in breast cancer","volume":"28","author":"Denkert","year":"2010","journal-title":"J Clin Oncol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdt303","article-title":"Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013","volume":"24","author":"Goldhirsch","year":"2013","journal-title":"Ann Oncol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"290","DOI":"10.3322\/caac.21393","article-title":"Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual","volume":"67","author":"Giuliano","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022152","article-title":"Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer","volume":"347","author":"Fisher","year":"2002","journal-title":"N Engl J Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/s41568-024-00714-6","article-title":"Towards targeting the breast cancer immune microenvironment","volume":"24","author":"Harris","year":"2024","journal-title":"Nat Rev Cancer"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60892-6","article-title":"Oral poly(ADP-ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and advanced breast cancer: a proof-of-concept trial","volume":"376","author":"Tutt","year":"2010","journal-title":"Lancet"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr393","article-title":"Assessment of Ki67 in breast cancer: recommendations from the International Ki67 in Breast Cancer working group","volume":"103","author":"Dowsett","year":"2011","journal-title":"J Natl Cancer Inst"},{"key":"B40","doi-asserted-by":"publisher","first-page":"R68","DOI":"10.1186\/bcr2635","article-title":"Phenotypic and molecular characterization of the claudin-low intrinsic subtype of breast cancer","volume":"12","author":"Prat","year":"2010","journal-title":"Breast Cancer Res"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1690888\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:56:14Z","timestamp":1771926974000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1690888\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":40,"alternative-id":["10.3389\/fimmu.2026.1690888"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1690888","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]},"article-number":"1690888"}}