Platinum-based neoadjuvant chemotherapy in triple-negative breast cancer: An updated systematic review and...

Triple-negative breast cancer (TNBC) is a highly aggressive subtype of breast cancer that is characterized by its association with shortened survival durations and a heightened likelihood of recurrence. Platinum-based chemotherapy has been demonstrated to increase the rate of pathological complete response (pCR), yet its influence on long-term survival outcomes remains unclear. This meta-analysis aims to clarify the activity, efficacy, and safety of platinum-based regimens in this patient population.

We conducted a systematic search of PubMed and Web of Science up to October 13, 2024, to identify randomized controlled trials (RCTs) comparing platinum-based neoadjuvant chemotherapy (NACT) to platinum-free regimens in TNBC patients. Using random effects models, we calculated pooled odds ratios and hazard ratios with 95% confidence intervals for pCR (defined as ypT0/is pN0), event-free survival (EFS), overall survival, distant disease-free survival, invasive disease-free survival, and grade 3 and 4 adverse events.

A total of 12 RCTs involving 2650 patients were included in the analysis. Overall, platinum-based NACT significantly increased the pCR rate from 34.6% to 51.3%. This association remained significant when restricting the analysis to 7 RCTs (N = 1645) that utilized the same standard regimen of weekly paclitaxel (with or without carboplatin) followed by anthracycline and cyclophosphamide. Regarding survival outcomes, various RCTs reported different metrics: EFS, overall survival, distant disease-free survival, and invasive disease-free survival showed no significant differences.

Our meta-analysis showed that platinum-based NACT was associated with significantly increased pCR and EFS rates in TNBC patients. Although it entails an increased risk of grade 3/4 hematological toxicity, the risk is still manageable. These findings suggest that the addition of a platinum agent to standard neoadjuvant anthracycline- and taxane-based chemotherapy may be considered an option in TNBC patients.