Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 24;11(16):6286-6311.
doi: 10.18632/aging.102188. Epub 2019 Aug 24.

Efficacy and Safety of Neoadjuvant Chemotherapy Regimens for Triple-Negative Breast Cancer: A Network Meta-Analysis

Affiliations
Free PMC article

Efficacy and Safety of Neoadjuvant Chemotherapy Regimens for Triple-Negative Breast Cancer: A Network Meta-Analysis

Yunhai Li et al. Aging (Albany NY). .
Free PMC article

Abstract

Different neoadjuvant chemotherapies are available for triple-negative breast cancer (TNBC). Here, we performed a network meta-analysis to evaluate the pathological complete response (pCR) benefit and safety of treatment regimens. Pairwise and Bayesian network meta-analyses were performed to compare direct and indirect evidence, respectively. Twenty-three studies involving 12 regimens namely standard chemotherapeutic agents, bevacizumab (B)-, platinum salts (P)-, B plus P (BP)-, poly(ADP-ribose) polymerase inhibitors (Pi)-, P plus Pi (PPi)-, capecitabine (Ca)-, gemcitabine (Ge)-, zoledronic acid (Za)-, everolimus (E)-, P plus E (PE)-, and gefitinib (G)-containing regimens. The results showed that P-, B-, PPi-, and Za-containing regimens achieved higher pCR than standard chemotherapeutic agents. BP-containing regimens had a better pCR than B-containing regimens. In indirect comparisons, Za-, BP-, P-, and B-containing regimens were the top four strategies with the highest probability for pCR. Benefit-risk analysis showed that B-containing regimens had the highest acceptability of being the best treatment for better pCR achievement with fewer SAEs. The addition of P, B, BP, PPi, and Za to standard chemotherapeutic agents enhanced the pCR, but a balance between efficacy and safety should be carefully considered. B-containing regimens might be the best choice for neoadjuvant chemotherapy due to its better efficacy and tolerability.

Keywords: neoadjuvant chemotherapy; network meta-analysis; pathological complete response; triple-negative breast cancer.

Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A PRISMA flow chart of the literature search and study selection in this meta-analysis.
Figure 2
Figure 2
Network diagram of eligible comparisons included in the network meta-analysis for pathological complete response (pCR). The node size is proportional to the total number of patients in the regimen. The width of each line is proportional to the number of studies comparing the two regimens linked by the line.
Figure 3
Figure 3
Forest plots of pair-wise meta-analyses for pathological complete response (pCR). (A) Standard chemotherapeutic agents vs. P-containing regimens. (B) Standard chemotherapeutic agents vs. B-containing regimens. (C) B-containing regimens vs. BP-containing regimens. (D) Standard chemotherapeutic agents vs. PPi-containing regimens. (E) Standard chemotherapeutic agents vs. Ca-containing regimens. (F) Standard chemotherapeutic agents vs. Za-containing regimens.
Figure 4
Figure 4
Bayesian network meta-analysis for pathological complete response (pCR). (A) The league table of comparisons. Data are presented as odds radio (OR) and 95% confidence intervals (CI). An OR>1 favors the column-defining treatment, and an OR<1 favors the row-defining treatment. (B) Heatmap of the rank probability of the twelve regimens for pCR. Rank 1 represents the best treatment and rank 12 represents the worst. Rank probabilities sum to one, both within a rank over treatments and within a treatment over ranks.
Figure 5
Figure 5
Bayesian network meta-analysis for grade 3–4 hematological adverse events. (A) The league table for comparisons of anemia. (B) The league table for comparisons of neutropenia. (C) The league table for comparisons of thrombocytopenia. Data are presented as odds radio (OR) and 95% confidence intervals (CI). An OR>1 favors the row-defining treatment, and OR<1 favors the column-defining treatment.
Figure 6
Figure 6
Stochastic multi-criteria acceptability analysis for benefit-risk. (A) Rank probability of regimens based on synthesizing pCR and anemia. (B) Rank probability of regimens based on synthesizing pCR and neutropenia. (C) Rank probability of regimens based on synthesizing pCR and thrombocytopenia. (D) Rank probability of regimens based on synthesizing pCR and the three serious adverse events. Rank 1 represents the best treatment and rank N represents the worst. The proportion corresponds to the probability of each regimen to be at a specific rank.

Similar articles

See all similar articles

Cited by 1 article

References

    1. Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010; 363:1938–48. 10.1056/NEJMra1001389 - DOI - PubMed
    1. Joensuu H, Gligorov J. Adjuvant treatments for triple-negative breast cancers. Ann Oncol. 2012. (Suppl 6); 23:vi40–45. 10.1093/annonc/mds194 - DOI - PubMed
    1. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ, Martino S, Perez EA, Muss HB, Norton L, Hudis C, Winer EP. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA. 2006; 295:1658–67. 10.1001/jama.295.14.1658 - DOI - PMC - PubMed
    1. Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, Ollila DW, Sartor CI, Graham ML, Perou CM. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007; 13:2329–34. 10.1158/1078-0432.CCR-06-1109 - DOI - PubMed
    1. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, Bonnefoi H, Cameron D, Gianni L, Valagussa P, Swain SM, Prowell T, Loibl S, et al. . Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014; 384:164–72. 10.1016/S0140-6736(13)62422-8 - DOI - PubMed

Publication types

Feedback