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Updated: Aug 6, 2026
Studying Triple Negative Breast Cancer Using Orthotopic Breast Cancer Model
Published on: March 20, 2020
Comparative efficacy of subsequent-line therapies for advanced triple-negative breast cancer: a bayesian network
Zheng Xu1, Linxian Ding2, Tai Zhao2
1College of Mathematics, Beijing Normal University, Beijing, China.
Background:
Direct head-to-head randomized comparisons among emerging therapies are limited, making it difficult to determine the optimal subsequent-line treatment for advanced triple-negative breast cancer (TNBC). This study aimed to systematically compare the relative efficacy of second- and later-line regimens using a Bayesian network meta-analysis (NMA).
Methods:
PubMed, Embase, Web of Science, Cochrane Library and ClinicalTrials.gov were searched to 30 September 2025 for randomized controlled trials (RCTs) of second-/later-line advanced TNBC. A Bayesian NMA estimated effects on objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). SUCRA was used for ranking, and model convergence was assessed by Gelman-Rubin diagnostics. Single-arm studies were included only in sensitivity analyses using a down-weighted binomial model for ORR. Additional sensitivity analyses included ChemoC node splitting and evidence certainty assessment (CINeMA).
Results:
Thirty-one RCTs and 34 single-arm studies (11,048 patients; 22 regimens) were included. Antibody-drug conjugate (ADC)-based therapies showed the most favorable efficacy overall. Sacituzumab govitecan (SG), sacituzumab tirumotecan (ST), and trastuzumab deruxtecan (T-DXd) ranked highest for ORR and PFS, with consistent benefits for SG and ST versus chemotherapy. T-DXd showed benefit mainly in HER2-low, HR-negative patients. For OS, SG and ST demonstrated clear advantages, while T-DXd showed non-significant effects. Combination chemotherapy outperformed single-agent chemotherapy for ORR and PFS. PARP inhibitors and PD-1-based regimens showed inconsistent efficacy across outcomes. Sensitivity analyses confirmed that incorporating single-arm data and separating chemotherapy nodes did not materially change treatment rankings or overall conclusions.
Conclusion:
ADCs, particularly SG and ST, were generally associated with favorable efficacy across outcomes in the subsequent-line treatment of advanced TNBC. These results may support clinical decision-making, although heterogeneity in study populations and the absence of direct comparisons highlight the need for further head-to-head trials.
Insights
Antibody-drug conjugates (ADCs), like sacituzumab govitecan (SG) and sacituzumab tirumotecan (ST), show superior efficacy in advanced triple-negative breast cancer (TNBC) second-line treatment. These findings aid clinical decisions for TNBC patients.
Area of Science:
- Oncology
- Clinical Trials
- Pharmacology
Background:
- Optimal treatment sequencing for advanced triple-negative breast cancer (TNBC) is challenging due to limited head-to-head comparisons of emerging therapies.
- Advanced TNBC requires effective subsequent-line treatments to improve patient outcomes.
Purpose of the Study:
- To systematically compare the relative efficacy of second- and later-line treatment regimens for advanced TNBC.
- To utilize a Bayesian network meta-analysis (NMA) to synthesize evidence from randomized controlled trials (RCTs).
Main Methods:
- Conducted a Bayesian network meta-analysis (NMA) of RCTs for second-/later-line advanced TNBC, searching major databases up to September 2025.
- Assessed objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) as primary outcomes.
- Performed sensitivity analyses, including single-arm studies and evidence certainty assessment (CINeMA), to ensure robustness of findings.
Main Results:
- Antibody-drug conjugate (ADC)-based therapies demonstrated the most favorable overall efficacy.
- Sacituzumab govitecan (SG) and sacituzumab tirumotecan (ST) ranked highest for ORR and PFS, showing consistent benefits over chemotherapy.
- SG and ST showed clear advantages in OS, while trastuzumab deruxtecan (T-DXd) had non-significant OS effects and benefit mainly in HER2-low, HR-negative patients.
Conclusions:
- ADCs, particularly SG and ST, are highly effective in subsequent-line treatment for advanced TNBC.
- The findings support clinical decision-making for advanced TNBC management.
- The need for direct head-to-head trials is highlighted due to study population heterogeneity and lack of direct comparisons.
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