TNBC: NACT tied to worse OS than ACT, with variable subgroup findings in meta-analysis

  • Xia LY & al.
  • World J Surg Oncol
  • 15 Jun 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant chemotherapy (NACT) is associated with poorer OS than ACT, but with no difference in disease-free survival (DFS) in triple-negative breast cancer (TNBC).
  • However, the results for subgroups in this meta-analysis are conflicting.

Why this matters

  • Findings cast doubt on NACT, which has become the standard treatment for TNBC.
  • The results suggest that NACT could be adopted for patients with pathologic complete response (pCR), but not those with residual disease.

Study design

  • Meta-analysis by Chinese researchers of 9 retrospective and prospective studies involving 36,480 patients.
  • Funding: None.

Key results

  • Across all patients, NACT vs ACT was associated with worse OS (HR, 1.59; P=.0001), but with no difference between groups for DFS (HR, 0.85; P=.49).
  • In the subgroup of patients achieving pCR, NACT (vs ACT) was superior for OS (HR, 0.53; P=.04) and DFS (HR, 0.52; P=.03).
  • In the subgroup of patients with residual disease, NACT (vs ACT) was associated with worse OS (HR, 1.18; P<.0001 and dfs p=".0008).</li">

Limitations

  • Publication bias.
  • Most studies (7/9) were retrospective.