Shi Mingqiang, Li Zhoujuan, Shen Guoshuang, Wang Tianzhuo, Li Jinming, Wang Miaozhou, Liu Zhen, Zhao Fuxing, Ren Dengfeng, Zhao Jiuda
Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai, University & Affiliated Cancer Hospital of Qinghai University, Xining, Qinghai 810000, China.
Cancer Pathog Ther. 2023 Jun 13;2(2):81-90. doi: 10.1016/j.cpt.2023.06.002. eCollection 2024 Apr.
Metastatic triple-negative breast cancer (mTNBC) is an aggressive histological subtype with poor prognosis. Several first-line treatments are currently available for mTNBC. This study conducted a network meta-analysis to compare these first-line regimens and to determine the regimen with the best efficacy.
A systematic search of PubMed, EMBASE, the Cochrane Central Register of Controlled Bases, and minutes of major conferences was performed. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analyzed via network meta-analysis using the R software (R Core Team, Vienna, Austria). The efficacy of the treatment regimens was compared using hazard ratios and 95% confidence intervals.
A total of 29 randomized controlled trials involving 4607 patients were analyzed. The ranking was based on the surface under the cumulative ranking curve. Network meta-analysis results showed that cisplatin combined with nab-paclitaxel or paclitaxel was superior to docetaxel plus capecitabine in terms of PFS and ORR. For programmed death-ligand 1 (PD-L1) and breast cancer susceptibility gene ( mutation-positive tumors, atezolizumab/pembrolizumab combined with nab-paclitaxel and talazoparib was superior to docetaxel plus capecitabine. No significant difference was observed among the treatments in OS. Neutropenia, diarrhea, and fatigue were common serious adverse events.
Cisplatin combined with nab-paclitaxel or paclitaxel is the preferred first-line treatment for mTNBC. For PD-L1 and mutation-positive tumors, atezolizumab/pembrolizumab combined with nab-paclitaxel and talazoparib is an effective treatment option. Neutropenia, diarrhea, and fatigue are frequently occurring serious adverse events.
转移性三阴性乳腺癌（mTNBC）是一种侵袭性组织学亚型，预后较差。目前有几种一线治疗方案可用于mTNBC。本研究进行了一项网状荟萃分析，以比较这些一线治疗方案，并确定疗效最佳的方案。
对PubMed、EMBASE、Cochrane对照试验中心注册库和主要会议纪要进行了系统检索。使用R软件（R核心团队，奥地利维也纳）通过网状荟萃分析对无进展生存期（PFS）、总生存期（OS）和客观缓解率（ORR）进行分析。使用风险比和95%置信区间比较治疗方案的疗效。
共分析了29项涉及4607例患者的随机对照试验。排名基于累积排名曲线下面积。网状荟萃分析结果显示，就PFS和ORR而言，顺铂联合白蛋白结合型紫杉醇或紫杉醇优于多西他赛加卡培他滨。对于程序性死亡配体1（PD-L1）和乳腺癌易感基因（）突变阳性肿瘤，阿特珠单抗/帕博利珠单抗联合白蛋白结合型紫杉醇和他拉唑帕尼优于多西他赛加卡培他滨。各治疗方案在OS方面未观察到显著差异。中性粒细胞减少、腹泻和疲劳是常见的严重不良事件。
顺铂联合白蛋白结合型紫杉醇或紫杉醇是mTNBC的首选一线治疗方案。对于PD-L1和 突变阳性肿瘤，阿特珠单抗/帕博利珠单抗联合白蛋白结合型紫杉醇和他拉唑帕尼是一种有效的治疗选择。中性粒细胞减少、腹泻和疲劳是常见的严重不良事件。
