A network meta-analysis on the efficacy of targeted agents in combination with chemotherapy for treatment of advanced/metastatic triple-negative breast cancer
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Long Ge1,2,3,*, Yan Tang4,*, Qiu-Ning Zhang5, Jin-Hui Tian2,3, Xiao-Hu Wang4,5, Dawid Pieper6, Bei Pan7, Lun Li8, Juan Ling2,3, Zhi-Tong Bing9 and Ke-Hu Yang2,3
1First Clinical Medical College of Lanzhou University, Lanzhou 730000, P.R. China
2Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, P.R. China
3Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, P.R. China
4Second People’s Hospital of Lanzhou City, Lanzhou 730046, P.R. China
5Gansu Provincial Academic Institute for Medical Research, Gansu Provincial Cancer Hospital, Lanzhou 730050, P.R. China
6Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, 51109, Cologne, Germany
7School of Public Health of Lanzhou University, Lanzhou 730000, P.R. China
8Department of Breast-Thyroid Surgery, The Second Xiangya Hospital of Central South University, Changsha 410000, P.R. China
9Institute of Modern Physics of Chinese Academy of Sciences, Lanzhou 730000, P.R. China
Ke-Hu Yang, email: firstname.lastname@example.org
Keywords: targeted agents, chemotherapy, triple-negative breast cancer, network meta-analysis, randomized controlled trials
Received: January 31, 2017 Accepted: June 27, 2017 Published: July 08, 2017
Objective: Our network meta-analysis aimed to determine the assistant efficacy of targeted therapy in combined with chemotherapy for advanced/metastatic triple-negative breast cancer (TNBC).
Results: A total of 15 randomized controlled trials (RCTs), involving 2,410 patients, met our inclusion criteria. Eight targeted agents involving 11 treatment arms were included. The methodological quality of included RCTs was acceptable. The results of direct comparisons showed that progression-free survival (PFS) was significantly longer with bevacizumab+chemotherapy when compared to chemotherapy alone (hazard ratio [HR] = 0.62, 95% credible intervals [CrI]: 0.41–0.87). However, there were no statistically significant differences for all other direct comparison groups. The results of indirect comparison of different targeted agents revealed no significant differences regarding all outcomes of interest. According to ranking probabilities, all outcomes favored bevacizumab+chemotherapy and veliparib+chemotherapy. Bayesian and Frequentist network meta-analysis showed similar results, and the probability of bias of small-study effects was small.
Materials and Methods: A comprehensive literature search in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (via ISI Web of Knowledge), BIOSIS Previews (via ISI Web of Knowledge), and Chemical Abstracts (CA) was conducted to identify RCTs involving targeted agents in the treatment of advanced/metastatic TNBC. Two reviewers independently extracted related data and assessed the risk of bias of included studies. Bayesian network meta-analysis was conducted using R-3.3.2 software.
Conclusions: Limited evidence showed that targeted agents combined with chemotherapy for advanced/metastatic TNBC were slightly effective. Further investigation of targeted therapies for TNBC is required to improve patient outcomes. The registration number was CRD42014014299.
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