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

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.