Background: The role of platinum-based neoadjuvant chemotherapy in triple-negative breast cancer (TNBC) patients is highly
controversial and it is not endorsed by current guidelines. Our meta-analysis aimed to better elucidate its activity, efficacy and
safety.
Material and methods: A systematic search of Medline, Web of Science and conferences proceedings up to 30 October 2017
was carried out to identify randomized controlled trials (RCTs) investigating platinum-based versus platinum-free neoadjuvant
chemotherapy in TNBC patients. Using the fixed and random effects models, pooled odds ratios (ORs) and hazard ratios (HRs)
with 95% confidence intervals (CI) were calculated for pathological complete response (pCR, defined as ypT0/is pN0), event-free
survival (EFS), overall survival (OS) and grade 3 and 4 adverse events (AEs: neutropenia, anemia, thrombocytopenia and
neuropathy).
Results: Nine RCTs (N \ubc 2109) were included. Overall, platinum-based neoadjuvant chemotherapy significantly increased pCR
rate from 37.0% to 52.1% (OR 1.96, 95% CI 1.46\u20132.62, P < 0.001). Platinum-based neoadjuvant chemotherapy remained
significantly associated with increased pCR rate also after restricting the analysis to the three RCTs (N \ubc 611) that used the same
standard regimen in both groups of weekly paclitaxel (with or without carboplatin) followed by anthracycline and
cyclophosphamide (OR 2.53, 95% CI 1.37\u20134.66, P \ubc 0.003). Conversely, among the 96 BRCA-mutated patients included in two
RCTs, the addition of carboplatin was not associated with significantly increased pCR rate (OR 1.17, 95% CI 0.51\u20132.67, P \ubc 0.711).
Two RCTs (N \ubc 748) reported survival outcomes: no significant difference in EFS (HR 0.72, 95% CI 0.49\u20131.06, P \ubc 0.094) and OS
(HR 0.86, 95% CI 0.46\u20131.63, P \ubc 0.651) was observed.
A significant higher risk of grade 3 and 4 hematological AEs, with no increased risk of grade 3 and 4 neuropathy was observed
with platinum-based neoadjuvant chemotherapy.
Conclusion: In TNBC patients, platinum-based neoadjuvant chemotherapy is associated with significantly increased pCR rates
at the cost of worse hematological toxicities. Platinum-based neoadjuvant chemotherapy may be considered an option in TNBC
patients
