Neoadjuvant treatment regimens associated with pathological complete response in triple-negative breast cancer: a systematic review and network meta-analysis

INTRODUCTION: Triple-negative breast cancer (TNBC) lacks estrogen, progesterone, and HER2 receptors, limiting treatment options. Neoadjuvant anthracycline- and taxane-based chemotherapy remains standard, achieving pathological complete response (pCR) rates of 30%. We compared neoadjuvant treatments for early-stage TNBC using a systematic review and network meta-analysis (NMA). METHODS: PubMed, EMBASE, and Cochrane were searched for randomized and observational studies of neoadjuvant treatment in TNBC. Odds ratios (OR) with 95% confidence intervals were pooled using a random-effects model. Certainty of evidence was assessed with GRADE. Statistical analyses were performed using RStudio. RESULTS: Thirty-seven studies with 7.683 patients were included. Twenty-five treatment nodes were formed, with paclitaxel (P) or docetaxel (D) + anthracycline - based (A) chemotherapy as the main comparator. Compared with PA-based + cyclophosphamide, higher pCR rates were observed with PA-based + carboplatin + pembrolizumab + cyclophosphamide (OR 3,04) and PA - based + carboplatin + veliparib + cyclophosphamide (OR 2,67). When DA-based + cyclophosphamide was the comparator, DA-based + cyclophosphamide + bevacizumab (OR 1,67) increased pCR. The SUCRA ranked PA-based + carboplatin + pembrolizumab, paclitaxel + carboplatin + atezolizumab, and DA-based + lobaplatin as most effective. CONCLUSIONS: Platinum agents, PARP inhibitors, and immune checkpoint inhibitors were associated with higher pCR rates in early-stage TNBC. PROTOCOL REGISTRATION: CRD42025640277.