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Updated: Oct 8, 2025
Studying Triple Negative Breast Cancer Using Orthotopic Breast Cancer Model
Published on: March 20, 2020
ErbB inhibitors as neoadjuvant therapy for triple-positive breast cancer: a network meta-analysis
Danxiang Chen1, Lingli Jin1, Yiying Xu1
1Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University Nan Bai Xiang Street, Wenzhou 325006, Zhejiang, People's Republic of China.
Background:
Evidence on the effectiveness of ErbB inhibitor interventions for women with triple-positive breast cancer (TPBC) is scarce. Exposure to hormone receptors was reported to eclipse targeted intervention effectiveness. Here, we aimed to explore the optimum targeted regimen for TPBC.
Methods:
We conducted a thorough search of the literature focusing on neoadjuvant targeted therapy with both hormone receptor-positive and HER2 (ErbB2)-positive patients and performed a network meta-analysis comparing the regimens using a random-effects model. The rate of pathological complete response (pCR) (ypT0/is) was the primary outcome. The odds ratio (OR) with 95% confidence interval (CI) was used to assess the association among twelve regimens.
Results:
Thirteen studies meeting the inclusion criteria were included. Significantly more TPBC patients receiving ado-trastuzumab emtansine plus lapatinib experienced pCR events than other patients. In the high-performance ranking of the twelve regimens, ado-trastuzumab emtansine plus lapatinib (TDM-1+L) ranked top, followed by ado-trastuzumab emtansine (TDM-1), trastuzumab plus carboplatin, taxanes and pertuzumab (TCHP), trastuzumab plus docetaxel and lapatinib (THL), trastuzumab, taxanes and pertuzumab (THP), ado-trastuzumab emtansine plus pertuzumab (TDM1+P), trastuzumab plus taxanes (TH), trastuzumab plus taxanes and neratinib, taxanes plus pertuzumab (HP), taxanes and neratinib (HN), trastuzumab plus lapatinib (TL), trastuzumab plus pertuzumab (TP) in sequence.
Conclusion:
Double-targeted therapy in chemotherapy-based regimens was associated with better pCR than single-targeted therapy, and TDM-1+L stood out. For either single-targeted or double-targeted therapies, regimens free of chemotherapy were always worse than those with targeted therapy. Our data support guidelines that recommend combinations of chemotherapies plus targeted therapies in the neoadjuvant setting for early TPBC.
Insights
The combination of ado-trastuzumab emtansine plus lapatinib (TDM-1+L) is the most effective neoadjuvant regimen for triple-positive breast cancer (TPBC). Chemotherapy-based targeted therapies show superior pathological complete response (pCR) rates compared to non-chemotherapy regimens.
Area of Science:
- Oncology
- Pharmacology
- Genetics
Background:
- Limited evidence exists for ErbB inhibitor effectiveness in triple-positive breast cancer (TPBC).
- Hormone receptor positivity may reduce the efficacy of targeted interventions.
- Identifying optimal targeted regimens for TPBC is crucial.
Purpose of the Study:
- To explore the optimal targeted regimen for triple-positive breast cancer (TPBC).
- To compare the effectiveness of various neoadjuvant targeted therapies for TPBC.
Main Methods:
- A systematic literature search was conducted for neoadjuvant targeted therapy in hormone receptor-positive and HER2-positive patients.
- A random-effects network meta-analysis was performed comparing twelve regimens.
- Pathological complete response (pCR) rate was the primary outcome, assessed using odds ratios (OR) with 95% confidence intervals (CI).
Main Results:
- Thirteen studies were included in the analysis.
- Ado-trastuzumab emtansine plus lapatinib (TDM-1+L) demonstrated significantly higher pCR rates compared to other regimens.
- The top-ranked regimens included TDM-1+L, TDM-1, TCHP, THL, THP, TDM1+P, TH, and others, in descending order of efficacy.
Conclusions:
- Double-targeted therapy combined with chemotherapy significantly improved pCR rates in TPBC compared to single-targeted therapy.
- Regimens incorporating chemotherapy were more effective than those without chemotherapy.
- The findings support current guidelines recommending neoadjuvant chemotherapy plus targeted therapy combinations for early-stage TPBC.
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