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目前，三阴性乳腺癌术前新辅助治疗的最佳方案尚不明确。近年来的研究结果表明，联合铂类或帕博利珠单抗，有望提高三阴性乳腺癌术前新辅助治疗的病理完全缓解比例。 2020年7月13日，美国乳腺疾病学会《乳腺杂志》在线发表美国纽约西奈山医院、伊坎医学院、西奈山贝斯以色列综合癌症中心、日本医科大学附属医院的网络荟萃分析报告，探讨了最有效的三阴性乳腺癌术前新辅助全身治疗方案。 作者首先通过美国国家医学图书馆、荷兰医学文摘、科睿唯安文献数据库，对三阴性乳腺癌患者不同新辅助治疗方案的对比研究进行检索。随后进行网络荟萃分析，利用随机效应模型对不同的治疗方案进行比较，重点关注蒽环类、贝伐珠单抗、帕博利珠单抗、铂类。全部研究方案都包括紫杉类。对病理完全缓解比例以及发热伴中性粒细胞减少、3～4级血小板减少、恶心呕吐和腹泻的发生比例进行分析。 结果，对符合上述条件的13项随机对照研究进行分析，比较了10种不同类型的治疗方案：
根据药物安全性分析：
因此，该研究结果表明，对于三阴性乳腺癌术前新辅助治疗，贝伐珠单抗、帕博利珠单抗或铂类可以显著提高病理完全缓解比例，不过三者联合的疗效尚不明确。此外，蒽环类对于三阴性乳腺癌新辅助治疗的好处尚不明确，故有必要进一步开展头对头比较研究。 2020年7月13日 乳腺癌重要研究 Breast J. 2020 Jul 13. Online ahead of print. Neo-adjuvant therapy for triple-negative breast cancer: Insights from a network meta-analysis. Miyashita H, Satoi S, Cruz C, Malamud SC. Icahn School of Medicine at Mount Sinai, Mount Sinai/Beth Israel Comprehensive Cancer Center, New York, NY, USA; Nippon Medical School Hospital, Tokyo, Japan. BACKGROUND: The best regimen of neo-adjuvant therapy for triple-negative breast cancer (TNBC) is unknown. Recent studies have shown promising data that adding carboplatin or pembrolizumab improves the rate of pathologic complete response (pCR) in TNBC. Therefore, we performed a network meta-analysis to define the overall, most effective, neo-adjuvant systemic therapy for TNBC. METHODS: We searched for studies comparing different neo-adjuvant regimens in patients with TNBC. We performed a network meta-analysis comparing the regimens using the random-effects model. We focused on anthracycline, bevacizumab, pembrolizumab, and platinum salts (Pl). All study regimens contained a taxane. We analyzed the rate of pCR (ypT0/is, N0), and the incidence of febrile neutropenia, grade 3-grade 4 thrombocytopenia, nausea/vomiting, and diarrhea. RESULTS: We identified a total of 13 randomized control trials for this analysis. We compared ten different classes of regimens. We found that regimens containing Pl were significantly superior to non-PI-containing regimens for the rate of pCR. Similarly, pembrolizumab-containing regimens were associated with significantly higher pCR rates. Regimens containing bevacizumab significantly increased the rate of pCR as well. However, it was equivocal as to whether the addition of Pl to pembrolizumab-containing regimen increases pCR rates. Adding anthracycline into the regimen did not show an improved rate of pCR. In the safety analysis, regimens containing Pl were associated with a significantly higher incidence of febrile neutropenia and grade 3-grade 4 thrombocytopenia. The regimen containing anthracycline plus bevacizumab plus Pl was associated with a higher risk of gastrointestinal adverse events. CONCLUSIONS: For TNBC, regimens containing bevacizumab, pembrolizumab, or Pl are most effective in terms of pCR rates, though it is unclear whether combining all these medications has the greatest efficacy. Additionally, the benefit of using anthracycline in the neo-adjuvant therapy regimen for TNBC is not apparent, which may warrant a further head-to-head comparison. KEYWORDS: anthracycline, neo-adjuvant, pembrolizumab, platinum salts, triple-negative breast cancer DOI: 10.1111/tbj.13978
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