Efficacy and safety of platinum-based, anthracycline-free neoadjuvant chemotherapy for triple-negative breast cancer: a systematic review and meta-analysis

This study examines the effectiveness of platinum-based anthracycline-free neoadjuvant chemotherapy (NAC) combined with taxanes in treating triple-negative breast cancer (TNBC). Studies published up to January 2025 were systematically retrieved from PubMed, Web of Science, Embase, and the Cochrane Library. A pooled analysis was conducted to assess the pathological complete response (pCR) rate, adverse events (AEs), and survival outcomes. Subgroup analyses were performed to examine the influence of different chemotherapy regimens and patient characteristics on treatment efficacy. A total of 30 studies involving 3,637 TNBC patients were included in the analysis. The pooled overall survival (OS) rate was 69.92% (95% confidence interval (CI): 41.65%-88.33%), with 2-year, 3-year, and 5-year OS rates of 95.38% (95% CI: 86.64%-98.50%), 94.63% (95% CI: 87.91%-97.71%), and 86.97% (95% CI: 80.76%-91.39%), respectively. Among secondary outcomes, the pooled disease-free survival (DFS) rate was 77.53% (95% CI: 69.54%-83.91%), and the pCR rate was 46.45% (95% CI: 42.55%-50.39%). The most frequently reported hematologic AEs included anemia, neutropenia, and leukopenia, while the most common non-hematologic AEs were nausea and vomiting, along with elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Subgroup analyses demonstrated that the combination of docetaxel and carboplatin achieved a higher pCR rate (52.00%) compared to paclitaxel plus carboplatin (42.00%). Concerning geographic origin, the highest pCR rate was observed in patients from the United States (50.00%), followed by Germany (46.00%) and China (40.00%). In terms of OS, the highest survival rate was reported with paclitaxel plus lobaplatin (94.00%), followed by carboplatin (80.00%) and cisplatin (45.00%). Platinum-based anthracycline-free NAC regimens combined with taxanes appear to be both effective and well-tolerated in patients with TNBC. Nevertheless, in the absence of randomized controlled trials (RCTs) directly comparing this approach to anthracycline-based regimens, further investigation is warranted to substantiate these findings.