Efficacy and safety of neoadjuvant therapy for triple-negative breast cancer: a Bayesian network meta-analysis

ABSTRACTBackground Numerous studies have concentrated on neoadjuvant therapies for treating triple-negative breast cancer (TNBC) that improve the pathological complete response (pCR) rate but remain controversial. We conducted a network meta-analysis (NMA) to objectively explore the efficacy and safety of different neoadjuvant regimens.Methods Phase II/III randomized clinical trials that compared different neoadjuvant therapies for TNBC were included. NMA and pairwise meta-analysis were performed using WinBUGS (version 1.4.3) and Review Manager 5.3.Results Forty-four studies with 8459 patients met the eligibility criteria. The NMA of pCR showed that programmed cell death Protein-1 and programmed cell death Ligand-1 inhibitors (PD-1/PD-L1), bevacizumab (Bev), zoledronic acid (ZOL), and platinum salts plus poly polymerase inhibitors (Pt+PARPi) may be favorable for TNBC neoadjuvant therapy. Chemotherapy combined with platinum salts or nanoparticle albumin-bound paclitaxel (Nab-p) has additional beneficial effects. However, neo-type drugs may also have increased toxicity.Conclusion PD-1/PD-L1, Bev, ZOL, and Pt+ PARPi-containing regimens improved the pCR rate compared to traditional chemotherapy, including anthracyclines and taxanes. Chemotherapy with platinum salts or Nab-p improved the pCR rate. Nevertheless, the balance between efficacy and toxicity should be evaluated rigorously. PD-1/PD-L1-containing regimens appear to be the most favorable for TNBC neoadjuvant therapy, with good efficacy and tolerance.KEYWORDS: network meta-analysistriple-negativebreast cancerneoadjuvant chemotherapypathological complete response Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Author contributionsYYS and ZJ contributed equally to this work. SCG and YYS conceived the study. YYS, ZJ, and KSH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. LYX and LXY designed the search strategy. YYS and ZJ screened the abstracts and full texts, acquired the data, and judged the risk of bias in the studies. YYS, LXY, and LYX performed data analyses. YYS and ZJ wrote the first draft of this manuscript. LYX, KSH, LXY and SCG critically revised the manuscript. All authors approved the final version of the manuscript.Informed consentAs this study contained data released from published literature, informed consent was not needed.Data availability statementAll data generated or analyzed during this study are included in this published article [and its supplementary information files].Supplementary materialSupplemental data for this article can be accessed online at https://doi.org/10.1080/14737140.2022.2125381Additional informationFundingThis paper was not funded.