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Efficacy and acceptability of neoadjuvant endocrine therapy in patients with hormone receptor‐positive breast cancer: A network meta‐analysis
Author(s) -
Zhang Tingting,
Feng Fubin,
Yao Yan,
Qi Lingyu,
Tian Jinhui,
Zhou Chao,
Dong Shengjie,
Wang Xue,
Sun Changgang
Publication year - 2019
Publication title -
journal of cellular physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.529
H-Index - 174
eISSN - 1097-4652
pISSN - 0021-9541
DOI - 10.1002/jcp.28068
Subject(s) - letrozole , medicine , oncology , anastrozole , breast cancer , exemestane , lapatinib , aromatase inhibitor , tamoxifen , cancer , trastuzumab
Background The optimal sequence of endocrine therapy in a neoadjuvant setting for hormone receptor‐positive (HR+) breast cancer is unclear. Our study evaluated the efficacy and acceptability of neoadjuvant endocrine therapy for HR+ breast cancer. Methods We identified studies based on titles and abstracts that were published before 22 June 2018 in the following databases: PubMed, EMBASE, and the Cochrane Library. Eligible studies were randomised controlled trials with at least one arm that evaluated the effectiveness of one or a combination of anastrozole, letrozole, palbociclib, tamoxifen, fulvestrant, abemaciclib, everolimus, gefitinib, ribociclib, taselisib, and exemestane. We pooled effect sizes using the odds ratio (OR) and corresponding 95% credibility interval (95% CrI). The primary outcomes were response rate and treatment completion. Results Our network meta‐analysis included 3,306 participants and 16 eligible studies, which assessed 15 treatments. In terms of response rates, compared with letrozole combined therapy, tamoxifen was associated with a significant reduction in response rate (OR, 0.34; 95% CrI, 0.13–0.85; OR, 0.32; 95% CrI, 0.13–0.80; OR, 0.26; 95% CrI, 0.09–0.83; and OR, 0.30; 95% CrI, 0.09–0.96; for letrozole plus everolimus, letrozole plus taselisib, letrozole plus zoledronic acid, and letrozole plus lapatinib, respectively). Based on the surface under the cumulative ranking curves ranking, letrozole plus zoledronic acid was associated with the highest rate of response (87.6%), followed by letrozole plus lapatinib (85.2%), and letrozole plus taselisib (79.3%). Conclusions Ultimately, our study established that letrozole plus zoledronic acid may be an optimal treatment based on its current rank in a neoadjuvant setting for HR+ breast cancer.