Oncology Unit, ASST Bergamo Ovest, Treviglio, BG, Italy.
Oncology Unit, Casa di cura Igea, Milan, Italy.
Curr Probl Cancer. 2024 Jun;50:101096. doi: 10.1016/j.currproblcancer.2024.101096. Epub 2024 Apr 11.
There are multiple neoadjuvant regimens, including platinum agents for triple-negative breast cancer (TNBC), each with a different safety profile, outcome, and pathologic complete response rate (pCR%). We performed a systematic review and network meta-analysis to compare the efficacy and safety of different platinum-based neoadjuvant CT treatments for TNBC.
Bibliographic databases (PubMed, Embase, and Cochrane Library) were searched from their inception to October 31, 2022. Eligible studies were randomized clinical trials that evaluated the addition of carboplatin or cisplatin to standard neoadjuvant CT for TNBC. The primary endpoints were pCR rates and DFS/EFS, while the secondary endpoints were grade (G)3-4 hematological toxicity and OS.
Thirteen trials involving 3154 patients comparing six treatments (carboplatin AUC 5, carboplatin AUC 6, carboplatin AUC 2, carboplatin AUC 1.5, cisplatin 75 mg/m2, and standard anthracycline-and/or taxane-based CT) were identified. Based on the most effective treatments added to neoadjuvant CT, carboplatin AUC 2 was associated with the least improvement in pCR% (RR, 1.49; 95%CI, 1.23, 1.8), carboplatin AUC 6 was associated with similar improvement in pCR% (RR 1.58, 95%CI, 1.35, 1.84) and carboplatin AUC 5 with the highest improvement in pCR% (RR 2.23, 95%CI, 1.6,32). The treatment associated with the most considerable improvement in DFS when added to neoadjuvant CT was carboplatin AUC 5 (HR 0.36, 95%CI 0.18, 0.73). It was also better than AUC 6 and AUC 2 (HR= 0.45, 95%CI 0.21-0.96 and HR=0.48, 95%CI 0.23-0.98). All schedules exhibited similar outcomes in terms of OS; however, only AUC 2 demonstrated a significant improvement compared to the no-platinum arms. Neutropenia, thrombocytopenia, and anemia G3-4 were significantly increased by carboplatin AUC 6.
Based on this network meta-analysis, carboplatin AUC 5 added to standard neoadjuvant CT may provide substantial pCR and DFS benefits with a low toxicity risk compared to other carboplatin doses.
有多种新辅助方案，包括用于三阴性乳腺癌（TNBC）的铂类药物，每种方案的安全性、结果和病理完全缓解率（pCR%）都不同。我们进行了一项系统评价和网络荟萃分析，以比较不同基于铂类的新辅助 CT 治疗 TNBC 的疗效和安全性。
从文献数据库（PubMed、Embase 和 Cochrane Library）的成立到 2022 年 10 月 31 日进行了文献检索。纳入的研究是评估卡铂或顺铂联合标准新辅助 CT 治疗 TNBC 的随机临床试验。主要终点是 pCR 率和DFS/EFS，次要终点是 3-4 级血液学毒性和 OS。
共确定了 13 项涉及 3154 例患者的试验，比较了 6 种治疗方法（卡铂 AUC5、卡铂 AUC6、卡铂 AUC2、卡铂 AUC1.5、顺铂 75mg/m2 和标准蒽环类和/或紫杉烷类 CT）。基于新辅助 CT 中添加的最有效的治疗方法，卡铂 AUC2 与 pCR%的最小改善相关（RR，1.49；95%CI，1.23，1.8），卡铂 AUC6 与相似的 pCR%改善相关（RR，1.58；95%CI，1.35，1.84），而卡铂 AUC5 与 pCR%的最大改善相关（RR，2.23；95%CI，1.6，32）。与新辅助 CT 联合使用时，在改善 DFS 方面最显著的治疗方法是卡铂 AUC5（HR，0.36；95%CI，0.18，0.73）。它也优于 AUC6 和 AUC2（HR=0.45；95%CI，0.21-0.96 和 HR=0.48；95%CI，0.23-0.98）。所有方案在 OS 方面的结果相似；然而，只有 AUC2 与无铂臂相比显示出显著改善。卡铂 AUC6 显著增加了中性粒细胞减少症、血小板减少症和贫血 3-4 级。
基于这项网络荟萃分析，与其他卡铂剂量相比，卡铂 AUC5 联合标准新辅助 CT 可能提供显著的 pCR 和 DFS 获益，同时具有较低的毒性风险。
