scholarly journals Survival benefit of platinum-based regimen in early stage triple negative breast cancer: A meta-analysis of randomized controlled trials

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Lei Bian ◽  
Ping Yu ◽  
Jiahuai Wen ◽  
Na Li ◽  
Wanwei Huang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trials ◽  
Triple Negative Breast Cancer ◽  
Survival Data ◽  
Survival Benefit ◽  
Triple Negative ◽  
Early Stage ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

AbstractPlatinum (Pt)-based chemo-regimens have been proved effective in neoadjuvant and salvage chemotherapy of triple negative breast cancer (TNBC). However, the survival benefit of Pt-based regimens in early stage TNBC(eTNBC) treatment has remained unclear. We conducted a meta-analysis to explore its role in improving the clinical outcomes of eTNBC. We carried out a comprehensive literature search on 15 March 2021 for randomized controlled trials (RCTs) comparing ajuvant/neoadjuvant Pt-based and Pt-free chemo-regimens in eTNBC patients, according to PRISMA 2020. We extracted the survival data and utilized the STATA software to calculate the summarized hazard ratios (HRs) and 95% confidence interval (95% CI) for overall survival (OS) and disease-free survival (DFS). Seven eligible RCTs enrolling a total of 2,027 eTNBC patients were identified in this meta-analysis, with 1,007 receiving Pt-free regimens, and the other 1,020 patients receiving Pt-based regimens, respectively. Patients in Pt-based regimens arm were associated with significant improved DFS (HR = 0.70, 95% CI: 0.58–0.84), and OS (HR = 0.78, 95% CI: 0.61–1.00). The survival benefits of DFS remained consistent in both the two strategies of Pt usage, either adding Pt to standard anthracyclines&taxanes based regimens (A&T + Pt), or combination of Pt and taxanes alone (TPt). The survival benefits also remained consistent in either neoadjuvant or adjuvant use of Pt. The present meta-analysis of RCTs revealed that Pt-based chemo-regimens could significantly improve both DFS and OS for eTNBC patients. Based on efficiency and toxicity, we recommend Pt-based regimens for eTNBC, especially the “A&T + Pt” mode if the toxicities are tolerable, which may lead TNBC therapy into a new era.

scholarly journals Platinum-Based Chemotherapy and Immunotherapy in Early Triple-Negative Breast Cancer: A Meta-Analysis and Indirect Treatment Comparison

2021 ◽  
Vol 11 ◽  
Author(s):  
Qin He ◽  
Yicheng Peng ◽  
Jie Sun ◽  
Jianxia Liu
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Survival Data ◽  
Triple Negative ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Controlled Trials ◽  
Platinum Drugs ◽  
Treatment Comparison ◽  
Platinum Based Chemotherapy

BackgroundTriple-negative breast cancer (TNBC) comprises 15% of invasive breast cancers. Platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) have been extensively researched in recent years as promising treatments in the neoadjuvant setting. However, clinical data is lacking in direct comparisons of these two treating regimens.MethodsWe conducted an online search on PubMed, Embase, Cochrane Online Library and key oncological meetings for available randomized controlled trials (RCTs) investigating ICIs or platinum drugs versus anthracyclines and taxane-based neoadjuvant chemotherapy (AT-based NACT). Conventional meta-analyses were conducted separately, and then indirect comparisons for clinical efficacy and safety profile were performed between ICIs and platinum drugs using AT-based NACT as a common comparator.ResultsSeven random controlled trials (RCTs) with 1,647 patients were included in the meta-analysis. The indirect comparison demonstrated that ICIs plus chemotherapy significantly improved pathological complete response (pCR) rate (p = 0.00445, OR, 1.78; 95%CI, 0.70–4.53), and decreased the adverse effect (AE) related discontinuance versus platinum-based chemotherapy (P = 0.00015; OR 0.46; 95%CI, 0.26–0.82).ConclusionICIs plus chemotherapy showed increased pCR rate and decreased adverse effects compared with platinum-based chemotherapy in early TNBC. However, subgroup analysis and survival data to explore the proper patients for each treatment remains scarce. Therefore, further studies with powered direct comparisons of these two treating regimens are required.

Efficacy and Safety of Neoadjuvant Immunotherapy in Triple Negative Breast Cancer: Meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Yakup Ergun ◽  
Cengiz Karacin ◽  
Baran Akagunduz ◽  
Sema Turker ◽  
Yusuf Acikgoz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled

Abstract Aim: In this meta-analysis; The efficacy and safety of randomized controlled trials (RCTs) using immunotherapy in the neoadjuvant treatment of triple negative breast cancer were investigated.Material and Method: To determine the studies to be evaluated in this meta-analysis, PubMed, Cochrane Library databases, and the studies published/presented in ASCO, ESMO, and SABCS congresses were thoroughly searched. Studies published/presented until January 01, 2021, were included. PCR, by definition, was defined as the absence of invasive cancer cells in the breast and axillary lymph nodes (ypT0 / Tis and N0). If there were at least two studies that shared the same subgroup results, subgroup analyzes were also performed. This meta-analysis was performed using Review Manager, version 5.4 (RevMan), a proprietary software provided by Cochrane Collaboration.Results: A total of 5 RCTs were included in the study, and 1498 patients were analyzed. In a pooled analysis of these studies, pCR was 58.8% in the immunotherapy arm and 42.6% in the placebo arm. According to the random-effects model, OR was found to be 1.77 (95% CI 1.23-2.56). In the pooled analysis of 3 studies reporting results according to PD-L1 level, immunotherapy significantly increased pCR in the PD-L1 positive group (67% vs. 49%, OR: 1.99, 95% CI 1.47-269). In the PD-L1 negative group, although immunotherapy increased pCR numerically, it was not statistically significant (42% vs. 33%, OR: 1.44, 95% CI 0.97-2.14). According to the lymph node status, the results were shared in 2 studies. In the joint analysis of these two studies, pCR was significantly increased with immunotherapy in those with positive lymph nodes (63% vs. 39%, OR: 2.52 95% CI 1.69-3.77). In those with negative lymph nodes, although immunotherapy increased pCR numerically, the difference was not significant (62% vs. 54%, OR: 1.36 95% 0.94-1.97).Conclusion: The addition of immunotherapy to neoadjuvant chemotherapy increases pCR. This increase was especially pronounced in high-risk patients with lymph node-positive and in the group with positive for PD-L1.

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