Comparative Effectiveness of Paclitaxel-Containing Regimens for Treatment of Triple-Negative Breast Cancer: A Network Meta-Analysis

IF 3.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Evidence‐Based Medicine Pub Date : 2025-06-04 DOI:10.1111/jebm.70037

Junqiang Niu, Xuan Tuo, Xu Hui, Man Li, Suyi Liu, Zhichun Zhang, Jianming Tang, Yongbin Lu, Kehu Yang

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引用次数: 0

Abstract

Objective

To evaluate the efficacy and safety of paclitaxel-based regimens, including traditional Chinese medicine (TCM) combinations, for the treatment of triple-negative BC (TNBC) using a network meta-analysis.

Methods

PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, CBM, VIP, WanFang database were searched comprehensively from inception to February 27, 2025. Eligible studies included adult TNBC patients treated with paclitaxel alone or in combination with other therapies. Outcomes included objective response rate (ORR), overall survival (OS), progression-free survival, pathologic complete response, disease-free survival, and adverse events (AEs). Statistical analyses were performed using the frequentist contrast-based method and random effects model. The Grading of Recommendations, Assessment, Development, and Evaluation approach using CINeMA application and a modified Cochrane Risk of Bias Tool were used to assess the certainty of evidence and methodological quality.

Results

93 randomized controlled trials (108 publications) involving 19,016 patients were included. Paclitaxel-based quadruple and quintuple therapies significantly improved ORR (relative risk (RR) = 1.74, 95% confidence interval (CI) [1.39–2.71], low certainty of evidence) and OS duration (weighted mean difference (WMD) = 59.16 weeks, 95% CI [28.81–89.51], low) compared to monotherapy. Paclitaxel-based monotherapy and double therapy had the least potential to cause neutropenia. Regimens incorporating TCM showed superior ORR compared to non-TCM combinations and monotherapy (18 randomized controlled trials, 1570 patients; RR = 1.29. 95% CI [1.17–1.41], moderate; RR = 1.55, 95% CI [1.37–1.75], moderate).

Conclusions

Combination therapies, especially those incorporating targeted agents or platinum-based regimens, may exhibit superior efficacy while maintaining acceptable safety profiles. Additionally, TCM may be associated with a higher ORR and a reduced risk of AEs. Further large-scale, high-quality studies are warranted to investigate the efficacy and safety of combining paclitaxel with targeted agents, platinum-based therapies, or TCM in the treatment of TNBC.

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含紫杉醇方案治疗三阴性乳腺癌的比较疗效：网络荟萃分析

目的通过网络荟萃分析，评价以紫杉醇为基础，包括中药联合用药治疗三阴性BC （TNBC）的疗效和安全性。方法综合检索PubMed、EMBASE、Cochrane Library、Web of Science、CNKI、CBM、VIP、万方数据库，检索时间为建库至2025年2月27日。符合条件的研究包括单独使用紫杉醇或与其他疗法联合治疗的成年TNBC患者。结果包括客观缓解率（ORR）、总生存期（OS）、无进展生存期、病理完全缓解期、无病生存期和不良事件（ae）。采用基于频率对比的方法和随机效应模型进行统计分析。采用推荐分级、评估、发展和评价方法，使用CINeMA应用程序和改进的Cochrane偏倚风险工具来评估证据的确定性和方法质量。结果纳入93项随机对照试验（108篇出版物），19016例患者。与单药治疗相比，紫杉醇为基础的四联和五联治疗显著改善了ORR(相对风险（RR) = 1.74, 95%可信区间（CI）[1.39-2.71]，证据确定性低）和OS持续时间（加权平均差(WMD) = 59.16周，95% CI[28.81-89.51]，低）。紫杉醇为基础的单药治疗和双药治疗引起中性粒细胞减少的可能性最小。与非中药联合或单药治疗相比，中药联合方案的ORR更高(18项随机对照试验，1570例患者；Rr = 1.29。95% CI[1.17-1.41]，中度；RR = 1.55, 95% CI[1.37 ~ 1.75]，中度)。结论：联合治疗，特别是那些结合靶向药物或铂类药物的方案，可能在保持可接受的安全性的同时表现出更好的疗效。此外，中医可能与较高的ORR和较低的ae风险相关。需要进一步开展大规模、高质量的研究，以调查紫杉醇联合靶向药物、铂类药物或中药治疗TNBC的疗效和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.