目的:本研究旨在评估各种新辅助治疗方案对诊断为早期或局部晚期三阴性乳腺癌(TNBC)患者的疗效和安全性。
方法:Medline,EMBASE,科克伦图书馆,和WebofScience于2020年5月进行了检索,以确定随机对照试验(RCT)。进行贝叶斯网络荟萃分析(NMA)(注册:PROSPEROCRD42020223012)。
结果:共审查了35项RCT,涉及8,424名参与者,其中22个RCTs和5,203例患者被纳入该NMA,重点关注病理完全缓解(pCR)。基于蒽环类紫杉烷的(AT)方案联合铂(ATPt)[优势比(OR)=2.04,95%可信间隔(CrI):1.69,2.48]方案,多西他赛联合卡铂(TCb;OR=2.16,95%CrI:1.20,3.91)方案可改善pCR,超过仅AT。AT和ATPt联合靶向治疗[包括贝伐单抗(Bev),维利帕里布,阿替珠单抗,或pembrolizumab]也改善了pCR。该NMA中包含的五个RCT报告了严重不良事件(SAE)或≥3级AE。TCb与单独AT(OR=0.66,95%CrI:0.23,1.72)的≥3级AE较少。相比之下,ATPt,AT+Bev,ATPt+Bev,ATPt+veliporib,与单独使用AT相比,ATPt+pembrolizumab与更多的SAE相关.
结论:在TNBC患者中,基于铂的新辅助方案ATPt和TCb增加pCR超过单独使用AT,但TCb似乎比AT或ATPt耐受性更好。以铂为基础的方案结合靶向治疗(Bev,PARPi,和PD-1/PD-L1抑制剂)也提高了pCR率,超过了单独使用AT的pCR率,但这种益处伴随着更大的毒性。
OBJECTIVE: This study aimed to assess the efficacy and safety of various neoadjuvant regimens for patients diagnosed with early-stage or locally advanced triple-negative breast cancer (TNBC).
METHODS: Medline, EMBASE, Cochrane Library, and Web of Science were searched in May 2020 to identify randomized controlled trials (RCTs). Bayesian network meta-analysis (NMA) was performed (Registration: PROSPERO CRD42020223012).
RESULTS: A total of 35 RCTs involving 8,424 participants were reviewed, of which 22 RCTs with 5,203 patients were included in this NMA focusing on pathologic complete response (pCR). An anthracycline-taxane-based (AT) regimen combined with a platinum (ATPt) [odds ratio (OR) = 2.04, 95% credible interval (CrI): 1.69, 2.48] regimen, and a docetaxel regimen combined with a carboplatin (TCb; OR = 2.16, 95% CrI: 1.20, 3.91) regimen improved pCR beyond that with AT only. AT and ATPt combined with targeted therapy [including bevacizumab (Bev), veliparib, atezolizumab, or pembrolizumab] also improved pCR. Five RCTs included in this NMA reported serious adverse events (SAEs) or grade ≥ 3 AEs. TCb was associated with fewer grade ≥ 3 AEs than was AT (OR = 0.66, 95% CrI: 0.23, 1.72) alone. In contrast, ATPt, AT + Bev, ATPt + Bev, ATPt + veliparib, and ATPt + pembrolizumab were associated with more SAEs than was AT alone.
CONCLUSIONS: In patients with TNBC, platinum-based neoadjuvant regimens ATPt and TCb increase pCR beyond that with AT alone, but TCb appears to be better tolerated than either AT or ATPt. Platinum-based regimens combined with targeted therapies (Bev, PARPi, and PD-1/PD-L1 inhibitor) also improve the pCR rate beyond that with AT alone, but this benefit is accompanied by greater toxicity.