Efficacy and safety of neoadjuvant therapy for HR-positive/HER2-negative early breast cancer: a Bayesian network meta-analysis.

IF 2.9 3区 医学 Q2 ONCOLOGY Expert Review of Anticancer Therapy Pub Date : 2024-07-01 Epub Date: 2024-05-17 DOI:10.1080/14737140.2024.2350105
Ruiliang Chen, Yushuai Yu, Jie Zhang, Chuangui Song, Chuan Wang
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Abstract

Background: Neoadjuvant treatment for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer is controversial and requires a comprehensive analysis for optimal therapy assessment. Therefore, a two-step Bayesian network meta-analysis (NMA) was performed to compare the efficacy and safety of different neoadjuvant regimens.

Research design and methods: Phase II/III randomized clinical trials comparing various neoadjuvant therapies for HR+/HER2- breast cancer were included. NMA and pairwise meta-analyses were conducted using Stata (version 14), R (version 4.2.3), and Review Manager 5.4.

Results: Twenty-eight studies (5,625 patients) were eligible. NMA of objective response rate (ORR) indicated the highest SUCRA for chemotherapy (CT) and chemotherapy with anthracycline (CT(A)). Pathologic complete response (PCR) NMA demonstrated significant PCR improvement with chemotherapy regimens containing programmed cell death protein-1 and programmed cell death ligand-1 inhibitors (PD-1i/PD-L1i) and poly ADP-ribose polymerase inhibitors (PARPi). Combined analysis considering both the ORR and safety highlighted CT(A)'s efficacy and toxicity balance.

Conclusions: CT(A) and CT showed improved ORR compared with alternative regimens. CT(A) combined with PD-1/PD-L1 or PARP inhibitors significantly increased PCR rates. Comprehensive assessment of both ORR and safety indicated that CT(A) represents an optimal neoadjuvant therapy for HR+/HER2- breast cancer, whereas AI + CDK4/6 inhibitors rank solely behind chemotherapy.

Registration: PROSPERO Registration: CRD42024538948. International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) registration number INPLASY202440092.

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HR阳性/HER2阴性早期乳腺癌新辅助疗法的疗效和安全性:贝叶斯网络荟萃分析。
背景:激素受体阳性/人表皮生长因子受体2阴性(HR+/HER2-)乳腺癌的新辅助治疗存在争议,需要进行综合分析以评估最佳疗法。因此,我们进行了两步贝叶斯网络荟萃分析(NMA),以比较不同新辅助治疗方案的疗效和安全性:研究设计:纳入了比较HR+/HER2-乳腺癌各种新辅助疗法的II/III期随机临床试验。使用Stata(版本14)、R(版本4.2.3)和Review Manager 5.4进行了NMA和配对荟萃分析:28项研究(5625名患者)符合条件。客观反应率(ORR)的NMA显示,化疗(CT)和蒽环类药物化疗(CT(A))的SUCRA最高。病理完全反应(PCR)NMA显示,含有程序性细胞死亡蛋白-1和程序性细胞死亡配体-1抑制剂(PD-1i/PD-L1i)以及聚ADP-核糖聚合酶抑制剂(PARPi)的化疗方案能显著改善PCR。对ORR和安全性的综合分析突出了CT(A)的疗效和毒性平衡:结论:与其他方案相比,CT(A)和CT的ORR有所提高。CT(A)联合PD-1/PD-L1或PARP抑制剂可显著提高PCR率。对ORR和安全性的综合评估表明,CT(A)是治疗HR+/HER2-乳腺癌的最佳新辅助疗法,而AI+CDK4/6抑制剂仅次于化疗:国际注册系统综述和元分析协议平台(INPLASY)注册号:INPLASY202440092。
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来源期刊
CiteScore
5.10
自引率
3.00%
发文量
100
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches. Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.
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