Regimens of neo-adjuvant chemotherapy in the treatment of breast cancer: A systematic review & network meta-analysis with PRISMA-NMA compliance

•The relative efficacy of three regimens (targeted therapy, Taxane and Anthracyclines) assessed simultaneously using network meta-analysis.•Evidences derived from network meta-analysis under present studies are graded using GRADE approach.•Addition of Trastuzumab to NACT improves response for HER2-n...

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Published in:Critical reviews in oncology/hematology 2020-09, Vol.153, p.103015-103015, Article 103015
Main Authors: Pathak, Mona, Deo, Suryanarayana VS, Dwivedi, Sada Nand, Thakur, Bhaskar, Sreenivas, Vishnubhatla, Rath, Goura Kishore
Format: Article
Language:English
Subjects:
Anthracyclines
Bevacizumab
Breast cancer
Breast conserving surgery
Neo-adjuvant therapy
Pathological complete response
Taxanes
Trastuzumab
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Summary:•The relative efficacy of three regimens (targeted therapy, Taxane and Anthracyclines) assessed simultaneously using network meta-analysis.•Evidences derived from network meta-analysis under present studies are graded using GRADE approach.•Addition of Trastuzumab to NACT improves response for HER2-neu positive breast cancer.•Addition of Bevacizumab to NACT improves response for HER2-neu negative breast cancer.•Regimens of NACT have similar rate of breast conservation. Efficacy of neo-adjuvant therapy depends on the used regimens. There are contradictory findings regarding relative efficacy of these regimens. Accordingly, present study assessed the relative efficacy of Anthracyclines, Taxanes and added targeted therapies in neo-adjuvant setting simultaneously with a focus on tumor response and breast conserving surgery among breast cancer patients. The network meta-analysis model was used. Ranking of treatment was done by surface under cumulative ranking curve for each regimen. Out of 1286 screened records obtained by searching PubMed and Cochrane register of controlled trials, a total of 34 studies randomizing 12,630 breast cancer patients were included. Network meta-analysis for pathological complete response (pCR) revealed Addition of targeted therapies especially Trastuzumab for HER2+ breast cancer and Bevacizumab for HER2- breast cancer along with Anthracyclines and/or Taxanes based chemotherapy significantly improves pCR but with increased haematological toxicities. All the regimens performed similar in terms of breast conserving surgery rates.
ISSN:1040-8428
1879-0461
DOI:10.1016/j.critrevonc.2020.103015