Efficacy of different neoadjuvant treatment regimens in BRCA-mutated triple negative breast cancer: a systematic review and meta-analysis.

IF 2 4区医学 Q3 ONCOLOGY

Hereditary Cancer in Clinical Practice Pub Date : 2022-09-09 DOI:10.1186/s13053-022-00242-0

Olga Caramelo, Cristina Silva, Francisco Caramelo, Cristina Frutuoso, Leonor Pinto, Teresa Almeida-Santos

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引用次数: 0

Abstract

Purpose: Triple negative breast cancer (TNBC) is an aggressive breast cancer strongly associated with BRCA mutation. Standard neoadjuvant chemotherapy remains the standard of care for early stage TNBC, the optimal chemotherapy regimen is still a matter of discussion. Other agents, such as poly-ADP-ribosyl polymerase inhibitors (PARPi) and anti-vascular endothelial growth factor (VEGF) antibodies were evaluated in the neoadjuvant setting. This systematic review and meta-analysis intend to evaluate the impact of neoadjuvant treatments in pCR rates in TNBC gBRCA mutation, beyond traditional standard chemotherapy.

Methods: PubMed, Clinicaltrials.gov, Cochrane CENTRAL, Embase and key oncological meetings for trials were searched for studies reporting neoadjuvant chemo-immunotherapy in BRCA positive TNBC.

Results: Out of 1238 records reviewed, thirty-one trials were included, resulting in a total 619 BRCA-mutated TNBC patients. In BRCA mutated TNBC patients who received cisplatin in monotherapy the proportion of patients who achieved pCR was 0.53 (95%CI [0.30, 0.76]), and when treatment combined standard chemotherapy and platin derivatives the proportion of pCR increased to 0.62 (95% CI [0.48, 0.76]). The group of patients treated with platin derivatives, anthracyclines ± taxanes achieved the highest proportion of pCR, 0.66. Patients treated with PARPi alone show a pCR proportion of 0.55 (95% CI [0.30, 0.81]); and when standard chemotherapy and platin derivatives were combined with PARPi the proportion of pCR did not vary.

Conclusions: Patients with BRCA mutated TNBC treated with cisplatin in monotherapy demonstrate inferior proportion in the pCR achievement when compared with standard chemotherapy plus platin derivates. The best pCR was achieved with platin derivates in association with anthracyclines ± taxanes. No difference in pCR was found between PARPi alone vs PARPi with standard chemotherapy.

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BRCA突变三阴性乳腺癌不同新辅助治疗方案的疗效：系统综述和荟萃分析。

目的：三阴性乳腺癌（TNBC）是一种侵袭性乳腺癌，与 BRCA 基因突变密切相关。标准的新辅助化疗仍是治疗早期 TNBC 的标准方法，但最佳化疗方案仍有待讨论。其他药物，如多-ADP-核糖基聚合酶抑制剂（PARPi）和抗血管内皮生长因子（VEGF）抗体，也在新辅助治疗中进行了评估。本系统综述和荟萃分析旨在评估在传统标准化疗之外，新辅助治疗对 TNBC gBRCA 突变患者 pCR 率的影响：方法：在PubMed、Clinicaltrials.gov、Cochrane CENTRAL、Embase和主要肿瘤学会议上检索了有关BRCA阳性TNBC新辅助化疗免疫疗法的研究：结果：在审查的1238条记录中，有31项试验被纳入，共纳入了619名BRCA突变的TNBC患者。在接受顺铂单药治疗的BRCA突变TNBC患者中，获得pCR的患者比例为0.53（95%CI [0.30，0.76]），而在联合标准化疗和铂衍生物治疗的患者中，获得pCR的比例增至0.62（95%CI [0.48，0.76]）。接受铂类衍生物、蒽环类药物和紫杉类药物治疗的一组患者获得 pCR 的比例最高，为 0.66。单独使用PARPi治疗的患者的pCR比例为0.55（95% CI [0.30，0.81]）；当标准化疗和铂类衍生物与PARPi联合使用时，pCR比例没有变化：结论：BRCA突变TNBC患者接受顺铂单药治疗与标准化疗加铂衍生物治疗相比，获得pCR的比例较低。铂类衍生物与蒽环类和类固醇类药物联合使用可获得最佳pCR。单用 PARPi 与 PARPi 联合标准化疗的 pCR 无差异。

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来源期刊

Hereditary Cancer in Clinical Practice 医学-肿瘤学

CiteScore

3.10

自引率

5.90%

发文量

审稿时长

>12 weeks

期刊介绍： Hereditary Cancer in Clinical Practice is an open access journal that publishes articles of interest for the cancer genetics community and serves as a discussion forum for the development appropriate healthcare strategies. Cancer genetics encompasses a wide variety of disciplines and knowledge in the field is rapidly growing, especially as the amount of information linking genetic differences to inherited cancer predispositions continues expanding. With the increased knowledge of genetic variability and how this relates to cancer risk there is a growing demand not only to disseminate this information into clinical practice but also to enable competent debate concerning how such information is managed and what it implies for patient care. Topics covered by the journal include but are not limited to: Original research articles on any aspect of inherited predispositions to cancer. Reviews of inherited cancer predispositions. Application of molecular and cytogenetic analysis to clinical decision making. Clinical aspects of the management of hereditary cancers. Genetic counselling issues associated with cancer genetics. The role of registries in improving health care of patients with an inherited predisposition to cancer.