Neoadjuvant therapy in triple-negative breast cancer: A systematic review and network meta-analysis. (December 2022)

• Record Type: Journal Article
• Authors: Lin, Ying-Yi; Gao, Hong-Fei; Yang, Xin; Zhu, Teng; Zheng, Xing-xing; Ji, Fei; Zhang, Liu-Lu; Yang, Ci-Qiu; Yang, Mei; Li, Jie-Qing; Cheng, Min-Yi; Wang, Kun
• Is Part Of: Breast. Volume 66(2022)
• Page Start: 126
• Page End: 135
• Publication Date: 2022-12
• Subjects: Neoadjuvant therapy -- Triple-negative breast cancer -- Network meta-analysis; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2022.08.006
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: 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. Highlights: The combination of PD-1 inhibitor with platinum and anthracycline- and taxane-based chemotherapy is currently the most efficacious regimen for early triple-negative breast cancer, in terms of pathologic complete response and disease-free/event-free survival. PD-1 inhibitor combined with platinum and anthracycline- and taxane-based chemotherapy was associated with wider toxicity spectrums and carries a higher risk of premature treatment discontinuation. The choice of chemotherapy backbone might be vital for maximizing the antitumor activity of PD-1 inhibitor.