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Impact of platinum-based chemotherapy on the prognosis of early triple-negative breast cancer: a systematic review and meta-analysis

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Abstract

Although platinum-based chemotherapy can improve pathologic complete response (pCR) in patients with triple-negative breast cancer (TNBC), the impact on survival of platinum-based neoadjuvant and adjuvant chemotherapy is still controversial. Our meta-analysis aimed at analyzing survival with platinum-based neoadjuvant and adjuvant chemotherapy in patients with TNBC. We searched PubMed, EMBASE, MEDLINE, Cochrane databases, and several major conferences up to January 2021. Fixed and random models were used for our meta-analysis. Disease-free survival (DFS), overall survival (OS), and side effects data were extracted from the included literature in addition to the corresponding pooled hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CIs). A total of nine studies involving 3247 patients were included. The pooled analysis suggested that compared with anthracycline- and/or paclitaxel-based chemotherapy, platinum-based chemotherapy could further improve DFS (HR = 0.56, 95% CI 0.45–0.67, p < 0.01) and OS (HR = 0.54, 95% CI 0.38–0.70, p < 0.01) in patients with TNBC. The subgroup analysis showed that platinum-based chemotherapy could further improve DFS (HR = 0.59, 95% CI 0.43–0.74, p < 0.01) and OS (HR = 0.61, 95% CI 0.40–0.83, p < 0.01) in neoadjuvant chemotherapy and DFS (HR = 0.53, 95% CI 0.37–0.69, p < 0.01) and OS (HR = 0.46, 95% CI 0.23–0.69, p < 0.01) in adjuvant chemotherapy compared with anthracycline- and/or paclitaxel-based chemotherapy in patients with TNBC. In addition, compared with anthracycline-based chemotherapy, platinum-based chemotherapy without anthracycline chemotherapy could further improve DFS (HR = 0.53, 95% CI 0.37–0.70, p < 0.01) and OS (HR = 0.46, 95%CI 0.19–0.72, p < 0.01) in patients with TNBC. Compared with anthracycline- and/or paclitaxel-based chemotherapy, all-grade diarrhea, fatigue, and grade ≥ 3 anemia were higher in platinum-based chemotherapy. In contrast, all-grade anemia, leukopenia, neutropenia, peripheral neuropathy, myalgia/arthralgia, cardiac toxicity were lower in platinum-based chemotherapy; grade ≥ 3 leukopenia, neutropenia and myalgia/arthralgia were also lower. Compared with anthracycline- and/or paclitaxel-based chemotherapy, platinum-based chemotherapy was more associated with improved DFS and OS in TNBC patients. The benefit of survival is consistent with platinum-based neoadjuvant and adjuvant chemotherapy. The side effects of platinum-based chemotherapy are tolerable.

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Data availability

All data generated or analyzed during this study are included in this published article, and referenced articles are listed in References section.

Abbreviations

TNBC:

Triple-negative breast cancer

HR:

Hazard ratio

CI:

Confidence interval

DFS:

Disease-free survival

OS:

Overall survival

NCCN:

National Comprehensive Cancer Network

ESMO:

European Society of Medical Oncology

ASCO:

American Society of Clinical Oncology

SABCS:

The San Antonio Breast Cancer Symposium

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis

RCT:

Randomized controlled trial

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

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Funding

This work was supported by grants from the Thousand Talents of Program of Highend Innovation of Qinghai Province in China (for Dr. Jiuda Zhao).

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Author notes

  1. Fuxing Zhao, Guoshuang Shen, Qiuxia Dong, and Yuanfang Xin have contributed equally.

  2. Fuxing Zhao, Guoshuang Shen, Qiuxia Dong, and Yuanfang Xin are Co-first authors.

Authors and Affiliations

  1. Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China

    Fuxing Zhao, Guoshuang Shen, Yuanfang Xin, Xingfa Huo, Miaozhou Wang, Zhen Liu, Yi Zhao, Dengfeng Ren, Qiqi Xie, Zhilin Liu, Zitao Li, Lihong Gao & Jiuda Zhao

  2. The Fifth People’s Hospital of Qinghai Province, The First Ward of Oncology, Xining, 810000, China

    Qiuxia Dong

  3. Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), The VIPII Gastrointestinal Cancer Division of Medical Department, Peking University Cancer Hospital and Institute, Beijing, 100142, China

    Feng Du

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Contributions

FZ, QD, GS and XY contributed to the writing of the manuscript. QD, XH, MW, ZL select the study to be included. YZ, DR, QX, ZL, FD, and ZL extracted the data needed for meta-analysis, and they also conducted data analysis. FZ, GS, and LG drafted the manuscript and designed the figures. JZ conceptualized the research, supervised the work, and contributed to the editing and writing of the final manuscript. JZ also responsible for resolving the differences of opinion between the authors. All authors read and approved the final manuscript.

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Correspondence to Jiuda Zhao.

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Zhao, F., Shen, G., Dong, Q. et al. Impact of platinum-based chemotherapy on the prognosis of early triple-negative breast cancer: a systematic review and meta-analysis. Clin Exp Med 23, 2025–2040 (2023). https://doi.org/10.1007/s10238-022-00940-y

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