BRCA; Bayesian network meta-analysis; HER2-low; Immunotherapy; PARP inhibitors; PD-L1; Pembrolizumab; Sacituzumab govitecan; Therapeutic algorithm; Trastuzumab deruxtecan; Triple negative breast cancer; Bevacizumab; Poly(ADP-ribose) Polymerase Inhibitors; B7-H1 Antigen; Paclitaxel; Humans; Bevacizumab/therapeutic use; Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use; Network Meta-Analysis; Antineoplastic Combined Chemotherapy Protocols; Bayes Theorem; Algorithms; Triple Negative Breast Neoplasms; Oncology; Radiology, Nuclear Medicine and Imaging; General Medicine
Abstract :
[en] Metastatic triple-negative breast cancer (mTNBC) is a poor prognostic disease with limited treatments and uncertain therapeutic algorithms. We performed a systematic review and multiple Bayesian network meta-analyses according to treatment line to establish an optimal therapeutic sequencing strategy for this lethal disease. We included 125 first-line trials (37,812 patients) and 33 s/further-lines trials (11,321 patients). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rates (ORR), overall survival (OS) and safety, for first and further lines, separately. We also estimated separate treatment rankings for the first and subsequent lines according to each endpoint, based on (surface under the cumulative ranking curve) SUCRA values. No first-line treatment was associated with superior PFS and OS than paclitaxel ± bevacizumab. Platinum-based polychemotherapies were generally superior in terms of ORR, at the cost of higher toxicity.. PARP-inhibitors in germline-BRCA1/2-mutant patients, and immunotherapy + chemotherapy in PD-L1-positive mTNBC, performed similar to paclitaxel ± bevacizumab. In PD-L1-positive mTNBC, pembrolizumab + chemotherapy was better than atezolizumab + nab-paclitaxel in terms of OS according to SUCRA values. In second/further-lines, sacituzumab govitecan outperformed all other treatments on all endpoints, followed by PARP-inhibitors in germline-BRCA1/2-mutant tumors. Trastuzumab deruxtecan in HER2-low mTNBC performed similarly and was the best advanced-line treatment in terms of PFS and OS after sacituzumab govitecan, according to SUCRA values. Moreover, comparisons with sacituzumab govitecan, talazoparib and olaparib were not statistically significant. The most effective alternatives or candidates for subsequent lines were represented by nab-paclitaxel (in ORR), capecitabine (in PFS) and eribulin (in PFS and OS).
Disciplines :
Oncology
Author, co-author :
Schettini, Francesco; Translational Genomics and Targeted Therapies in Solid Tumors, 08036 Barcelona, Spain, Department of Medical Oncology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain, Department of Medicine, University of Barcelona, 08036 Barcelona, Spain. Electronic address: schettini@clinic.cat
Venturini, Sergio; Department of Economic and Social Sciences, Catholic University of Sacred Heart - Cremona Campus, 26100 Cremona, Italy. Electronic address: sergio.venturini@unicatt.it
Giuliano, Mario; Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy. Electronic address: m.giuliano@unina.it
Lambertini, Matteo; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy, Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy. Electronic address: matteo.lambertini@unige.it
Pinato, David J; Division of Cancer, Department of Surgery and Cancer, Imperial College London, SW7 2AZ London, UK, Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", 28100 Novara, Italy. Electronic address: david.pinato@imperial.ac.uk
Onesti, Concetta Elisa ; Université de Liège - ULiège > Département des sciences cliniques ; Clinical and Oncological Research Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
De Placido, Pietro; Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
Harbeck, Nadia; Breast Center, Department OB&GYN and CCCLMU, LMU University Hospital, 81377 Munich, Germany. Electronic address: nadia.harbeck@med.uni-muenchen.de
Lüftner, Diana; Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany. Electronic address: diana.lueftner@charite.de
Denys, Hannelore; Department of Medical Oncology, UZ Gent, 9000 Gent, Belgium. Electronic address: hannelore.denys@ugent.be
Van Dam, Peter; Oncology Department, University Hospital Antwerp (UZA), 2650 Edegem, Belgium. Electronic address: peter.vandam@uza.be
Arpino, Grazia; Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy. Electronic address: grazia.arpino@unina.it
Mustacchi, Giorgio; Medical Oncology, University of Trieste, 34127 Trieste, Italy. Electronic address: mail@mustacchioncology.it
Gligorov, Joseph; Department of Medical Oncology, Tenon Hospital, Institut Universitaire de Cancérologie AP-HP, Sorbonne University, 75004 Paris, France. Electronic address: joseph.gligorov@tnn.aphp.fr
Awada, Ahmad; Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Bruxelles, Belgium. Electronic address: ahmad.awada@bordet.be
Campone, Mario; Medical Oncology, Institut de Cancérologie de l'Ouest-Pays de la Loire, 44800 Saint-Herblain, France. Electronic address: mario.campone@ico.unicancer.fr
Wildiers, Hans; Department of General Medical Oncology, University Hospital Leuven, 3000 Leuven, Belgium. Electronic address: hans.wildiers@uzleuven.be
Gennari, Alessandra; Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", 28100 Novara, Italy. Electronic address: alessandra.gennari@uniupo.it
Tjan-Heijnen, Vivianne; Medical Oncology, Maastricht University Medical Center (MUMC), 6229 HX Maastricht, Netherlands. Electronic address: vcg.tjan.heijnen@mumc.nl
Bartsch, Rupert; Division of Oncology, Department of Medicine 1, Medical University of Vienna, 1090 Vienna, Austria. Electronic address: rupert.bartsch@meduniwien.ac.at
Cortes, Javier; International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain, Medica Scientia Innovation Research (MedSIR), Barcelona, Spain, Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ, USA, Vall d́Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain, Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain. Electronic address: jacortes@vhio.net
Paris, Ida; Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy. Electronic address: ida.paris@policlinicogemelli.it
Martín, Miguel; Departamento de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28007 Madrid, Spain. Electronic address: mmartin@geicam.org
De Placido, Sabino; Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy. Electronic address: deplacid@unina.it
Del Mastro, Lucia; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy, Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy. Electronic address: lucia.delmastro@hsanmartino.it
Jerusalem, Guy ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'oncologie médicale
Curigliano, Giuseppe; Istituto Europeo di Oncologia, IRCCS ed Università di Milano, 20141 Milano, Italy. Electronic address: giuseppe.curigliano@ieo.it
Prat, Aleix; Translational Genomics and Targeted Therapies in Solid Tumors, 08036 Barcelona, Spain, Department of Medical Oncology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain, Department of Medicine, University of Barcelona, 08036 Barcelona, Spain, Oncology Department, IOB Institute of Oncology, Quiron Group, 08023 Barcelona, Spain, SOLTI Cooperative Research Group, 08008 Barcelona, Spain. Electronic address: alprat@clinic.cat
Generali, Daniele; Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy, Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, 26100 Cremona, Italy. Electronic address: dgenerali@units.it
UNITS - Università degli Studi di Trieste [IT] FBBVA - Fundación BBVA [ES] ESMO - European Society for Medical Oncology [CH]
Funding text :
Dr F. Schettini is the recipient of an ESMO Fellowship – Translational and a BBVA Foundation – Hospital Clinic of Barcelona Joan Rodes – Josep Baselga Advanced Research Contract in Oncology. However, any views, opinions, findings, conclusions or recommendations expressed in this material are those solely of the authors and do not necessarily reflect those of Funders. This study was supported by MEDNotE, spin-off - University of Trieste, within the Mozart Program.
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