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Meta-Analysis
. 2017 Jan;38(1):18-23.
doi: 10.15537/smj.2017.1.14969.

Efficacy of carboplatin-based preoperative chemotherapy for triple-negative breast cancer. A meta-analysis of randomized controlled trials

Li-Yang Wang  1 , Hua Xie, Hang Zhou, Wen-Xiu Yao, Xin Zhao, Yi Wang
Affiliations
Meta-Analysis

Efficacy of carboplatin-based preoperative chemotherapy for triple-negative breast cancer. A meta-analysis of randomized controlled trials

Li-Yang Wang et al. Saudi Med J. 2017 Jan.

Abstract

Objectives: To evaluate the efficacy and safety of carboplatin-based preoperative chemotherapy in triple-negative breast cancer patients (TNBC).

Methods: PubMed, EMBASE, the Web of Science, the Cochrane Library, major clinical trial registries, and abstract collections from major international meetings were systematically searched for relevant randomized controlled trials. Endpoints included rates of pathologic complete response (pCR), overall response (ORR), breast-conserving surgery (BCS) and toxicity. Pooled relative risk (RR) was calculated for each endpoint using a fixed- or random-effect model depending on the heterogeneity among included studies.

Results: A total of 5 randomized controlled trials involving 1007 patients were included in the meta-analysis. Carboplatin-based chemotherapy was associated with a pooled pCR rate of 53.3%, which was significantly higher than the rate associated with non-carboplatin therapy (37.8%, RR: 1.41, 95% confidence interval [CI]: 1.23 to 1.62, p less than 0.00001). Compared with non-carboplatin therapy (48.1%), carboplatin-based chemotherapy increased BCS rate (59.7%, RR: 1.24, 95%CI: 1.06 to 1.46, p=0.007). Carboplatin-based chemotherapy was associated with similar ORR as non-carboplatin therapy. Carboplatin-based chemotherapy was associated with higher incidence of grade 3 or 4 anemia, neutropenia, febrile neutropenia, and thrombocytopenia than non-carboplatin therapy, while the 2 regimens were associated with similar incidence of fatigue, leucopenia, and nausea/vomiting.

Conclusion: The available evidence suggests that carboplatin-based preoperative chemotherapy is associated with significantly better pCR and BCS rates than non-carboplatin-based therapy in TNBC patients.

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Figures

Figure 1
Figure 1
Flow chart diagram of study selection. RCT - randomized controlled trials
Figure 2
Figure 2
Forest plot of pathologic complete response rate for carboplatin-based relative to non-carboplatin-based preoperative chemotherapy. M-H - Mantel-Haenszel test, CI - confidence interval
Figure 3
Figure 3
Forest plot of overall response for carboplatin-based relative to non-carboplatin-based preoperative chemotherapy. M-H - Mantel-Haenszel test, CI - confidence interval
Figure 4
Figure 4
Forest plot of breast-conserving surgery rate for carboplatin-based relative to non-carboplatin-based preoperative chemotherapy. M-H - Mantel-Haenszel test, CI - confidence interval
Figure 5
Figure 5
Funnel plot for publication bias in pathologic complete response analysis. SE - standard error, RR - relative risk
See this image and copyright information in PMC

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