Efficacy and acceptability of neoadjuvant endocrine therapy in patients with hormone receptor‐positive breast cancer: A network meta‐analysis

Abstract

Background The optimal sequence of endocrine therapy in a neoadjuvant setting for hormone receptor‐positive (HR+) breast cancer is unclear. Our study evaluated the efficacy and acceptability of neoadjuvant endocrine therapy for HR+ breast cancer. Methods We identified studies based on titles and abstracts that were published before 22 June 2018 in the following databases: PubMed, EMBASE, and the Cochrane Library. Eligible studies were randomised controlled trials with at least one arm that evaluated the effectiveness of one or a combination of anastrozole, letrozole, palbociclib, tamoxifen, fulvestrant, abemaciclib, everolimus, gefitinib, ribociclib, taselisib, and exemestane. We pooled effect sizes using the odds ratio (OR) and corresponding 95% credibility interval (95% CrI). The primary outcomes were response rate and treatment completion. Results Our network meta‐analysis included 3,306 participants and 16 eligible studies, which assessed 15 treatments. In terms of response rates, compared with letrozole combined therapy, tamoxifen was associated with a significant reduction in response rate (OR, 0.34; 95% CrI, 0.13–0.85; OR, 0.32; 95% CrI, 0.13–0.80; OR, 0.26; 95% CrI, 0.09–0.83; and OR, 0.30; 95% CrI, 0.09–0.96; for letrozole plus everolimus, letrozole plus taselisib, letrozole plus zoledronic acid, and letrozole plus lapatinib, respectively). Based on the surface under the cumulative ranking curves ranking, letrozole plus zoledronic acid was associated with the highest rate of response (87.6%), followed by letrozole plus lapatinib (85.2%), and letrozole plus taselisib (79.3%). Conclusions Ultimately, our study established that letrozole plus zoledronic acid may be an optimal treatment based on its current rank in a neoadjuvant setting for HR+ breast cancer.

Neoadjuvant endocrine therapy with or without palbociclib in low-risk patients: a phase III randomized double-blind SAFIA trial

“…These safety data suggest that palbociclib bears an acceptable safety profile in the MENA population. It has been noted that the mean age of our cohort is younger than the average reported in their western counterparts (Zhang et al 2019 ).…”

Effect of online interventions on reducing anxiety and depression for women with breast cancer: a systematic review and network meta-analysis protocol

“…In recent years, breast cancer has becoming the most common malignancy in women globally 2–4. Previous studies found that women with breast cancer suffered from negative psychological health 8.…”

“…WHO reported that approximate 2.26 million women suffered from breast cancer, with 685 000 deaths in 2020 1. Nowadays, breast cancer has been becoming one of the most common malignant tumours diagnosed with women and the main cause of cancer-related deaths worldwide 2–4. Despite the increased incidence of breast cancer, patients’ cure rate and survival time have been significantly increased because of the current standardised screening and diagnosis and the comprehensive treatments such as operation, chemotherapy, radiotherapy, hormonal and biological therapy 5 6.…”

Nuclear receptors: Lipid and hormone sensors with essential roles in the control of cancer development

“…Targeting components of the PI3K-AKT-mTOR pathway has been widely tested to treat endocrine refractory disease [42]. Dysregulation of the epidermal growth factor receptor (EGFR) family and their ligands has been reported [43], although results from clinical trials testing EGFR inhibitors in endocrine treatment-resistant breast cancer have been modest [44,45]. Variations of cell cycle components are also common in ER-positive breast cancer, including amplification of cyclin D1, gene copy gain of CDK4 and loss of negative regulators such as p16 and p18.…”