■本系统评价和网络荟萃分析(NMA)的目的是评估诊断为激素受体阳性的个体中各种新辅助治疗方案的有效性和安全性。her2阴性(HR+/HER2-)乳腺癌。
■在四个数据库中进行了系统搜索(Medline,Embase,WebofScience,和CENTRAL)从数据库开始到2024年1月16日,以确定被诊断为激素受体阳性的患者的各种新辅助治疗方案的随机对照试验(RCT),HER2阴性乳腺癌。进行网络荟萃分析以评估病理完全缓解(pCR)。
■分析中包括17项随机对照试验(RCT)。这些试验检查了16种不同的治疗方案,总共涉及5752名参与者。分析显示,HR+/HER2-乳腺癌的6种最有效的新辅助治疗方案是:CT(A)+奥拉帕尼(82.5%),CT(A)+纳武单抗(76.5%),Com(74.9%),CT(72.1%),单声道+艾瑞布林(72.0%),和CT(A)+pembrolizumab(70.4%)。病理完全缓解(pCR)的配对荟萃分析发现,包括蒽环类和免疫抑制剂的治疗方案与仅依赖蒽环类化疗的方案之间没有统计学上的显着差异(OR:1.14,95%ci0.79-1.64,I2=71%,P=0.50)。同样,以铂为基础的化疗和以蒽环类为基础的化疗之间没有显着差异(OR:1.37,95%CI0.53-3.56,I2=11%,P=0.52)。关于安全,观察到3-5级的不良反应,其中包括血液毒性,胃肠道反应,皮肤和粘膜反应,神经病,肝毒性,和心脏疾病。
■CT(A)+Olaparib组和CT(A)+nivolumab组在HR+/HER2-乳腺癌新辅助治疗中表现出优异的疗效。此外,重点是有效管理治疗方案的不良反应,以提高患者的耐受能力。鉴于当前研究的局限性,需要额外的执行良好且合适的随机对照试验来验证本研究的结果.尽管在某些情况下pCR在评估新辅助治疗的效果方面是有价值的,HR+/HER2-乳腺癌患者的预后预测和疗效评估应基于更广泛的临床和生物学特征.
■PROSPEROhttps://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42024534539,CRD42024501740。
UNASSIGNED: The objective of this systematic review and network meta-analysis (NMA) is to assess the effectiveness and safety of various neoadjuvant treatment protocols in individuals diagnosed with hormone receptor-positive, her2 negative(HR+/HER2-) breast cancer.
UNASSIGNED: A systematic search was conducted in four databases (Medline, Embase, Web of Science, and CENTRAL) from the inception of the databases to January 16, 2024, to identify randomized controlled trials (RCTs) to various neoadjuvant therapy options in patients diagnosed with hormone receptor-positive, HER2-negative breast cancer. A network meta-analysis was conducted to evaluate pathological complete response (pCR).
UNASSIGNED: There were 17 randomized controlled trials (RCTs) included in the analysis. These trials examined 16 different treatment regimens and involved a total of 5752 participants. The analysis revealed that the six most effective neoadjuvant treatment regimens for HR+/HER2- breast cancer were: CT(A)+olaparib (82.5%), CT(A)+nivolumab (76.5%), Com (74.9%), CT (72.1%), Mono+eribulin (72.0%), and CT(A)+pembrolizumab (70.4%).Paired meta-analysis for pathological complete response (pCR) found no statistically significant distinction between treatment regimens that included both anthracycline and immunosuppressants and regimens that relied solely on anthracycline chemotherapy(OR:1.14, 95%ci 0.79-1.64, I2 = 71%, P=0.50). Similarly, there was no significant difference between platinum-based chemotherapy and anthracycline-basedchemotherapy(OR:1.37, 95%ci 0.53- 3.56, I2 = 11%, P=0.52). With regards to safety, adverse effects of grade 3-5 were observed, which included haematological toxicity, gastrointestinal reactions, skin and mucous membrane reactions, neuropathy, hepatotoxicity, and cardiac disorders.
UNASSIGNED: The CT(A)+Olaparib and CT(A)+nivolumab groups demonstrated superior efficacy in neoadjuvant therapy for HR+/HER2- breast cancer. Furthermore, it is crucial to focus on effectively managing the adverse effects of the treatment plan to enhance patient\'s ability to tolerate it. Given the constraints of the current research, additional well-executed and suitable RCTs are necessary to validate the findings of this investigation. Although pCR is valuable in assessing the effect of neoadjuvant therapy in some cases, prognostic prediction and efficacy assessment in patients with HR+/HER2- breast cancer should be based on a combination of broader clinical and biological characteristics.
UNASSIGNED: PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024534539, CRD42024501740.