Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

Background: Triple-negative breast cancer constitutes approximately 12%-17% of all breast cancer cases, and >33% of patients develop distant metastases. Systemic cytotoxic chemotherapy is the primary treatment for patients with metastatic triple-negative breast cancer; however, the role of first-...

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Main Authors: Fei Lu MS, Yu Hou MS, Zhengting Chen PhD, Jie Jiang PhD, Xi He BS, Yaoxiong Xia MS, Ke Cao MS, Li Chang PhD, Wenhui Li PhD
Format: Article
Language:English
Published: SAGE Publishing 2021-05-01
Series:Technology in Cancer Research & Treatment
Online Access:https://doi.org/10.1177/15330338211016369
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spelling doaj-6c7429b3cc4046dc83a7c5fd781a20822021-05-13T03:33:27ZengSAGE PublishingTechnology in Cancer Research & Treatment1533-03382021-05-012010.1177/15330338211016369Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled TrialsFei Lu MS0Yu Hou MS1Zhengting Chen PhD2Jie Jiang PhD3Xi He BS4Yaoxiong Xia MS5Ke Cao MS6Li Chang PhD7Wenhui Li PhD8 Department of Oncology and Hematology, Southern Central Hospital of Yunnan Province, Mengzi, Yunnan, China Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, , Kunming, Yunnan, China Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, , Kunming, Yunnan, China Department of Medical Imagine, , Kunming, Yunnan, China Department of Pediatrics, Southern Central Hospital of Yunnan Province, Mengzi, Yunnan, China Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, , Kunming, Yunnan, China Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, , Kunming, Yunnan, China Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, , Kunming, Yunnan, China Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, , Kunming, Yunnan, ChinaBackground: Triple-negative breast cancer constitutes approximately 12%-17% of all breast cancer cases, and >33% of patients develop distant metastases. Systemic cytotoxic chemotherapy is the primary treatment for patients with metastatic triple-negative breast cancer; however, the role of first-line platinum-based chemotherapy in these patients remains controversial. This meta-analysis evaluated the efficacy and safety of platinum-based first-line chemotherapy for patients with metastatic triple-negative breast cancer. Methods: We systematically searched the PubMed, Embase, Cochrane, and Clinical Trials registry databases up to June 1, 2020 to identify randomized controlled trials that investigated platinum-based vs. first-line platinum-free chemotherapy in patients with metastatic triple-negative breast cancer. We used fixed and random effects models to calculate pooled hazard ratios and odds ratios with 95% confidence intervals for progression-free and overall survival, objective response rates, and grade 3 and 4 adverse events. Results: Four randomized controlled trials ( N = 590 patients) were included. Platinum-based chemotherapy significantly increased the objective response rates from 43.1% to 62.7% (odds ratio 2.34, 95% confidence interval 1.66-3.28, P < 0.001). Three randomized controlled trials ( N = 414 patients) reported survival outcomes. Patients administered platinum-based regimens showed significantly longer progression-free survival (hazard ratio 0.55, 95% confidence interval 0.37-0.82, P = 0.004) and a nonsignificant trend toward improved overall survival (hazard ratio 0.76, 95% confidence interval 0.57-1.00, P = 0.05). Only 2 studies reported the rates of grade 3 and 4 adverse events; grade 3-4 thrombocytopenia was more commonly associated with platinum-based chemotherapy (odds ratio 7.54, 95% confidence interval 1.37-41.60, P = 0.02) and grade 3-4 fatigue with platinum-free chemotherapy (odds ratio 0.23, 95% confidence interval 0.08-0.68, P = 0.008). Conclusions: First-line platinum-based chemotherapy was associated with significantly increased objective response rates, longer progression-free survival, and a nonsignificant trend toward improved overall survival in patients with metastatic triple-negative breast cancer at the high risk of grade 3-4 thrombocytopenia.https://doi.org/10.1177/15330338211016369
collection DOAJ
language English
format Article
sources DOAJ
author Fei Lu MS
Yu Hou MS
Zhengting Chen PhD
Jie Jiang PhD
Xi He BS
Yaoxiong Xia MS
Ke Cao MS
Li Chang PhD
Wenhui Li PhD
spellingShingle Fei Lu MS
Yu Hou MS
Zhengting Chen PhD
Jie Jiang PhD
Xi He BS
Yaoxiong Xia MS
Ke Cao MS
Li Chang PhD
Wenhui Li PhD
Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
Technology in Cancer Research & Treatment
author_facet Fei Lu MS
Yu Hou MS
Zhengting Chen PhD
Jie Jiang PhD
Xi He BS
Yaoxiong Xia MS
Ke Cao MS
Li Chang PhD
Wenhui Li PhD
author_sort Fei Lu MS
title Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_short Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_full Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_fullStr Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed Efficacy and Safety of Platinum-Based Chemotherapy as First-Line Therapy for Metastatic Triple-Negative Breast Cancer: A Meta-Analysis of Randomized Controlled Trials
title_sort efficacy and safety of platinum-based chemotherapy as first-line therapy for metastatic triple-negative breast cancer: a meta-analysis of randomized controlled trials
publisher SAGE Publishing
series Technology in Cancer Research & Treatment
issn 1533-0338
publishDate 2021-05-01
description Background: Triple-negative breast cancer constitutes approximately 12%-17% of all breast cancer cases, and >33% of patients develop distant metastases. Systemic cytotoxic chemotherapy is the primary treatment for patients with metastatic triple-negative breast cancer; however, the role of first-line platinum-based chemotherapy in these patients remains controversial. This meta-analysis evaluated the efficacy and safety of platinum-based first-line chemotherapy for patients with metastatic triple-negative breast cancer. Methods: We systematically searched the PubMed, Embase, Cochrane, and Clinical Trials registry databases up to June 1, 2020 to identify randomized controlled trials that investigated platinum-based vs. first-line platinum-free chemotherapy in patients with metastatic triple-negative breast cancer. We used fixed and random effects models to calculate pooled hazard ratios and odds ratios with 95% confidence intervals for progression-free and overall survival, objective response rates, and grade 3 and 4 adverse events. Results: Four randomized controlled trials ( N = 590 patients) were included. Platinum-based chemotherapy significantly increased the objective response rates from 43.1% to 62.7% (odds ratio 2.34, 95% confidence interval 1.66-3.28, P < 0.001). Three randomized controlled trials ( N = 414 patients) reported survival outcomes. Patients administered platinum-based regimens showed significantly longer progression-free survival (hazard ratio 0.55, 95% confidence interval 0.37-0.82, P = 0.004) and a nonsignificant trend toward improved overall survival (hazard ratio 0.76, 95% confidence interval 0.57-1.00, P = 0.05). Only 2 studies reported the rates of grade 3 and 4 adverse events; grade 3-4 thrombocytopenia was more commonly associated with platinum-based chemotherapy (odds ratio 7.54, 95% confidence interval 1.37-41.60, P = 0.02) and grade 3-4 fatigue with platinum-free chemotherapy (odds ratio 0.23, 95% confidence interval 0.08-0.68, P = 0.008). Conclusions: First-line platinum-based chemotherapy was associated with significantly increased objective response rates, longer progression-free survival, and a nonsignificant trend toward improved overall survival in patients with metastatic triple-negative breast cancer at the high risk of grade 3-4 thrombocytopenia.
url https://doi.org/10.1177/15330338211016369
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