Comparing efficacy of neoadjuvant therapy of triple-negative breast cancer: A Bayesian network meta-regression analysis

Abstract

Background: Triple-negative breast cancer (TNBC) is a subtype of breast cancer with a poor prognosis and limited treatment options. Currently, nonmetastatic TNBC is mostly treated with neoadjuvant chemotherapy, but comparisons between these neoadjuvant regimens are dearth.

Methods: PubMed, Embase, Medline, Cochrane Library, Web of ClinicalTrials.gov, and major international conference databases were systematically searched for randomized controlled trials (RCTs) on the efficacy of various neoadjuvant chemotherapy treatments in patients with TNBC from inception to January 2025. The primary research endpoint was the pathological complete response (pCR) rate. The secondary endpoint was the odds ratios (ORs) at different time points of event-free survival (EFS) and overall survival (OS). The tertiary endpoints were the hazard ratios (HRs) of EFS and OS compared by Bayesian network meta-analysis, as well as corresponding Bayesian network meta-regression analysis with the median follow-up time as the covariate. The above processes were conducted by RStudio 4.2.2 orchestrated with STATA 17.0 MP.

Results: For the primary endpoint, compared to regimens containing anthracycline and taxanes (AT), regimens containing anthracycline, taxanes, platinum, and programmed cell death protein-1 (ATPtPD1) showed significant higher pCR rate (OR = 5.68). For the secondary endpoint, compared to AT, ATPtPD1 showed significant longer EFS/OS. For EFS: OR = 2.28 at 18th month; OR = 2.43 at 24th month; OR = 3.21 at 30th month; OR = 4.23 at 36th month; OR = 4.62 at 42nd month; OR = 4.04 at 48th month. For OS: OR = 3.56 at 18th month; OR = 2.23 at 24th month; OR = 2.49 at 30th month; OR = 2.49 at 36th month; OR = 3.17 at 42nd month; OR = 2.97 at 48th month. For the tertiary endpoints, for HR of EFS, compared to AT, ATPtPD1 indicated significant advantage (HR = 2.24, 95% confidence interval [CI]: 1.42-3.59), after meta-regression analysis, shows advantages as well (HR = 2.29, 95% CI: 1.39-3.89). For HR of OS, compared to AT, ATPtPD1 indicated significant advantage (HR = 2.67, 95% CI: 1.03-7.35), after meta-regression analysis, shows advantages as well (HR = 2.70, 95% CI: 1.18-6.33).

Conclusions: Considering efficacy on pCR and OS/EFS together, ATPtPD1 should be considered as the best recommendation in neoadjuvant therapies of TNBC.

Keywords: Bayesian network meta-analysis; chemotherapy; immune checkpoint inhibitor; neoadjuvant treatment; network meta-regression analysis; triple-negative breast cancer.