Treatment for Triple-Negative Breast Cancer: An Umbrella Review of Meta-Analyses

Jianyun Yin,1 Changtai Zhu,2 Gaofeng Wang,3 Jianwei Gu1 1Thyroid Breast Surgery, Kunshan Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan, People’s Republic of China; 2Department of Transfusion Medicine, Shanghai Sixth Peoples’ Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 3Department of Gastroenterology, Kunshan Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan, People’s Republic of ChinaCorrespondence: Jianyun Yin, Thyroid Breast Surgery, Kunshan Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Kunshan, People’s Republic of China, Tel +86-0512-57310000, Email yinjianyun99@sina.comPurpose: In recent years, many meta-analyses of triple-negative breast cancer (TNBC) treatment have been published; however, these studies still lack systematic summary. Therefore, the aim of this study is to summarize and evaluate the evidence level and efficacy of treatment for TNBC.Materials and Methods: Retrospective and prospective studies on treatment of TNBC were searched in the PubMed, Embase, and Cochrane Library databases. The literature search deadline was June 30, 2021. Two investigators independently screened the literature and extracted the data. In addition, the joint World Health Organization–United Nations Food and Agriculture Organization expert consultation was used to evaluate the validity of the evidence.Results: A total of 28 meta-analyses were included in this study. The treatment interventions for TNBC mainly included surgery, chemotherapy (CT), radiotherapy, molecular targeted therapy, immunotherapy, zoledronic acid, and gonadotropin-releasing hormone (GnRH) analog. Platinum improves the pathological complete response (PCR) rate of patients treated with neoadjuvant chemotherapy (NACT), the objective remission rate (ORR) and overall survival (OS) in patients with metastatic triple-negative breast cancer. Capecitabine improves disease-free survival (DFS) and OS in patients treated with adjuvant CT. Bevacizumab was added to NACT to improve the PCR rate in patients. Immunotherapy improves the PCR rate in patients treated with NACT. The improvement in PCR rate in patients with high Ki67 expression treated with neoadjuvant therapy is highly suggestive. Other interventions had suggestive or weak evidence.Conclusion: Among the strategies for treating TNBC, platinum, bevacizumab, and immunotherapy can lead to better PCR rates as part of a NACT regimen. Capecitabine as adjuvant CT and platinum in the treatment of metastatic TNBC can benefit patients’ survival. However, the effectiveness of other interventions for TNBC is not yet clear. Further research is needed in the future to obtain more reliable clinical evidence.Keywords: triple-negative breast cancer, treatment, meta-analysis, umbrella review