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. 2021 Dec 21;7(1):157.
doi: 10.1038/s41523-021-00367-w.

Survival benefit of platinum-based regimen in early stage triple negative breast cancer: A meta-analysis of randomized controlled trials

Lei Bian #  1 , Ping Yu #  2 , Jiahuai Wen #  3 , Na Li  1 , Wanwei Huang  1 , Xiaoming Xie  1 , Feng Ye  4
Affiliations

Survival benefit of platinum-based regimen in early stage triple negative breast cancer: A meta-analysis of randomized controlled trials

Lei Bian et al. NPJ Breast Cancer. .

Abstract

Platinum (Pt)-based chemo-regimens have been proved effective in neoadjuvant and salvage chemotherapy of triple negative breast cancer (TNBC). However, the survival benefit of Pt-based regimens in early stage TNBC(eTNBC) treatment has remained unclear. We conducted a meta-analysis to explore its role in improving the clinical outcomes of eTNBC. We carried out a comprehensive literature search on 15 March 2021 for randomized controlled trials (RCTs) comparing ajuvant/neoadjuvant Pt-based and Pt-free chemo-regimens in eTNBC patients, according to PRISMA 2020. We extracted the survival data and utilized the STATA software to calculate the summarized hazard ratios (HRs) and 95% confidence interval (95% CI) for overall survival (OS) and disease-free survival (DFS). Seven eligible RCTs enrolling a total of 2,027 eTNBC patients were identified in this meta-analysis, with 1,007 receiving Pt-free regimens, and the other 1,020 patients receiving Pt-based regimens, respectively. Patients in Pt-based regimens arm were associated with significant improved DFS (HR = 0.70, 95% CI: 0.58-0.84), and OS (HR = 0.78, 95% CI: 0.61-1.00). The survival benefits of DFS remained consistent in both the two strategies of Pt usage, either adding Pt to standard anthracyclines&taxanes based regimens (A&T + Pt), or combination of Pt and taxanes alone (TPt). The survival benefits also remained consistent in either neoadjuvant or adjuvant use of Pt. The present meta-analysis of RCTs revealed that Pt-based chemo-regimens could significantly improve both DFS and OS for eTNBC patients. Based on efficiency and toxicity, we recommend Pt-based regimens for eTNBC, especially the "A&T + Pt" mode if the toxicities are tolerable, which may lead TNBC therapy into a new era.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The PRISMA flow diagram.
Fig. 2
Fig. 2. Overall efficiency for Pt-based regimen in early stage TNBC.
a Summarized HR for DFS, all RCTs included; b summarized HR for OS, all RCTs included; c summarized HR for DFS, with (Khalid, 2015) trial excluded; d summarized HR for OS, with (Khalid, 2015) trial excluded.
Fig. 3
Fig. 3. Subgroup analysis in eTNBC patients receiving “A&T + Pt” mode regimen.
a Summarized HR for DFS; b summarized HR for OS; c summarized HR for DFS, with (Khalid, 2015) trial excluded; d Summarized HR for OS, with (Khalid, 2015) trial excluded.
Fig. 4
Fig. 4. Subgroup analysis in eTNBC patients.
a Summarized HR for DFS in eTNBC patients receiving “TPt” regimen; b summarized HR for OS in eTNBC patients receiving “TPt” regimen; c summarized HR for DFS in LN negative eTNBC patients; d summarized HR for OS in LN positive eTNBC patients; e summarized HR for DFS in eTNBC receiving neoadjuvant Pt-based regimen; f summarized HR for OS in eTNBC receiving adjuvant Pt-based regimen.
Fig. 5
Fig. 5. Funnel plots and Egger’s test evaluating the publication bias.
No significant publication bias identified in the data pooling (Funnel plot in Fig. 5a–d corresponding to Fig. 2a–d).
See this image and copyright information in PMC

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