Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials
<i>Background and Objectives</i>: Currently, the standard treatment for non-metastatic triple-negative breast cancer (TNBC) consists of a systemic neoadjuvant (or perioperative) anthracycline plus taxane-based chemotherapy, delivered either sequentially or concomitantly. We performed a n...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/60/2/341 |
| _version_ | 1797297532910436352 |
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| author | Fausto Petrelli Gianluca Tomasello Maria Chiara Parati Antonio Ghidini Michele Ghidini Karen Borgonovo Mary Cabiddu Mara Ghilardi Roberto Reduzzi Donatella Gambini Alberto Zaniboni Giovanni Faustinelli Ornella Garrone |
| author_facet | Fausto Petrelli Gianluca Tomasello Maria Chiara Parati Antonio Ghidini Michele Ghidini Karen Borgonovo Mary Cabiddu Mara Ghilardi Roberto Reduzzi Donatella Gambini Alberto Zaniboni Giovanni Faustinelli Ornella Garrone |
| author_sort | Fausto Petrelli |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Currently, the standard treatment for non-metastatic triple-negative breast cancer (TNBC) consists of a systemic neoadjuvant (or perioperative) anthracycline plus taxane-based chemotherapy, delivered either sequentially or concomitantly. We performed a network meta-analysis (NMA) to compare the relative efficacy of different neoadjuvant treatments for TNBC in terms of pathologic complete response (pCR). <i>Materials and Methods</i>: The MEDLINE, Embase, and Cochrane databases were searched from database inception to 1 November 2023. Randomized clinical trials were used that enrolled adults with stage I-III TNBC and provided data on pCR defined as residual ypT0/TisN0M0. Between-group comparisons were estimated using risk ratios (RRs) with 95% credible intervals (95% CrIs). The primary outcome was the pCR rate. <i>Results</i>: 1129 citations were screened, and 12 randomized clinical trials were included. In Bayesian comparisons, all regimens, except anthracycline/taxanes plus gemcitabine or capecitabine, resulted in a higher pCR than the standard regimen in both direct and indirect comparisons. In particular, immunotherapy-based regimens resulted in more than double the pCR compared to historical regimens (RR = 2.3, 95% CI 1.9–2.9) and ranked as being the optimal regimen with a probability of 97%. Disease-free survival was better for immune checkpoint inhibitor-based chemotherapy (HR = 0.36, 95% 1.21–2.09) than for historical regimens. <i>Conclusion</i>: This meta-analysis confirmed that incorporating immunotherapy with neoadjuvant platinum-based chemotherapy is the best option to guarantee remarkable pathologic downstaging and improve clinical outcomes. |
| first_indexed | 2024-03-07T22:21:37Z |
| format | Article |
| id | doaj.art-447ce7c1855a4d538871ad2af9d3bfd5 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-07T22:21:37Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-447ce7c1855a4d538871ad2af9d3bfd52024-02-23T15:26:49ZengMDPI AGMedicina1010-660X1648-91442024-02-0160234110.3390/medicina60020341Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 TrialsFausto Petrelli0Gianluca Tomasello1Maria Chiara Parati2Antonio Ghidini3Michele Ghidini4Karen Borgonovo5Mary Cabiddu6Mara Ghilardi7Roberto Reduzzi8Donatella Gambini9Alberto Zaniboni10Giovanni Faustinelli11Ornella Garrone12Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyMedical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyOncology Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyOncology Unit, Casa di Cura Igea, 20129 Milano, ItalyMedical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyOncology Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyASP IMMEeS & PAT, 20146 Milano, ItalyOncology Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyBreast Unit, ASST Bergamo Ovest, 24047 Treviglio, ItalyMedical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyOncology Unit, Fondazione Poliambulanza, 25124 Brescia, ItalyASP IMMEeS & PAT, 20146 Milano, ItalyMedical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy<i>Background and Objectives</i>: Currently, the standard treatment for non-metastatic triple-negative breast cancer (TNBC) consists of a systemic neoadjuvant (or perioperative) anthracycline plus taxane-based chemotherapy, delivered either sequentially or concomitantly. We performed a network meta-analysis (NMA) to compare the relative efficacy of different neoadjuvant treatments for TNBC in terms of pathologic complete response (pCR). <i>Materials and Methods</i>: The MEDLINE, Embase, and Cochrane databases were searched from database inception to 1 November 2023. Randomized clinical trials were used that enrolled adults with stage I-III TNBC and provided data on pCR defined as residual ypT0/TisN0M0. Between-group comparisons were estimated using risk ratios (RRs) with 95% credible intervals (95% CrIs). The primary outcome was the pCR rate. <i>Results</i>: 1129 citations were screened, and 12 randomized clinical trials were included. In Bayesian comparisons, all regimens, except anthracycline/taxanes plus gemcitabine or capecitabine, resulted in a higher pCR than the standard regimen in both direct and indirect comparisons. In particular, immunotherapy-based regimens resulted in more than double the pCR compared to historical regimens (RR = 2.3, 95% CI 1.9–2.9) and ranked as being the optimal regimen with a probability of 97%. Disease-free survival was better for immune checkpoint inhibitor-based chemotherapy (HR = 0.36, 95% 1.21–2.09) than for historical regimens. <i>Conclusion</i>: This meta-analysis confirmed that incorporating immunotherapy with neoadjuvant platinum-based chemotherapy is the best option to guarantee remarkable pathologic downstaging and improve clinical outcomes.https://www.mdpi.com/1648-9144/60/2/341breast cancertriple negativeneoadjuvantchemotherapymeta-analysispathologic complete response |
| spellingShingle | Fausto Petrelli Gianluca Tomasello Maria Chiara Parati Antonio Ghidini Michele Ghidini Karen Borgonovo Mary Cabiddu Mara Ghilardi Roberto Reduzzi Donatella Gambini Alberto Zaniboni Giovanni Faustinelli Ornella Garrone Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials Medicina breast cancer triple negative neoadjuvant chemotherapy meta-analysis pathologic complete response |
| title | Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials |
| title_full | Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials |
| title_fullStr | Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials |
| title_full_unstemmed | Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials |
| title_short | Different Chemotherapy Regimens and Pathologic Complete Response in Triple-Negative Breast Cancer: An Updated Network Meta-Analysis of Phase 3 Trials |
| title_sort | different chemotherapy regimens and pathologic complete response in triple negative breast cancer an updated network meta analysis of phase 3 trials |
| topic | breast cancer triple negative neoadjuvant chemotherapy meta-analysis pathologic complete response |
| url | https://www.mdpi.com/1648-9144/60/2/341 |
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