Neoadjuvant therapy in triple-negative breast cancer: A
systematic review and network meta-analysis
by Ying-Yi Lin, Hong-Fei Gao, Xin Yang, Teng Zhu, Xing-xing
Zheng, Fei Ji, Liu-Lu Zhang, Ci-Qiu Yang, Mei Yang, Jie-Qing Li, Min-Yi Cheng,
Kun Wang
The Breast: August 19, 2022
Background
Evidence for the preferred neoadjuvant therapy regimen in
triple-negative breast cancer (TNBC) is not yet established.
Methods
Literature search was conducted from inception to February
12, 2022. Phase 2 and 3 randomized controlled trials (RCTs) investigating
neoadjuvant therapy for TNBC were eligible. The primary outcome was pathologic
complete response (pCR); the secondary outcomes were all-cause treatment
discontinuation, disease-free survival or event-free survival (DFS/EFS), and
overall survival. Odd ratios (OR) with 95% credible intervals (CrI) were used
to estimate binary outcomes; hazard ratios (HR) with 95% CrI were used to
estimate time-to-event outcomes. Bayesian network meta-analysis was implemented
for each endpoint. Sensitivity analysis and network meta-regression were done.
Results
41 RCTs (N = 7109 TNBC patients) were eligible. Compared
with anthracycline- and taxane-based chemotherapy (ChT), PD-1 inhibitor plus
platinum plus anthracycline- and taxane-based ChT was associated with a
significant increased pCR rate (OR 3.95; 95% CrI 1.81–9.44) and a higher risk
of premature treatment discontinuation (3.25; 1.26–8.29). Compared with
dose-dense anthracycline- and taxane-based ChT, the combined treatment was not
associated with significantly improved pCR (OR 2.57; 95% CrI 0.69–9.92). In
terms of time-to-event outcomes, PD-1 inhibitor plus platinum plus
anthracycline- and taxane-based ChT was associated with significantly improved
DFS/EFS (HR 0.42; 95% CrI 0.19–0.81).
Conclusions
PD-1 inhibitor plus platinum and anthracycline- and
taxane-based ChT was currently the most efficacious regimen for pCR and DFS/EFS
improvement in TNBC. The choice of chemotherapy backbone, optimization of
patient selection with close follow-up and proactive symptomatic managements
are essential to the antitumor activity of PD-1 inhibitor.
