Journal: Clinical pharmacology and therapeutics
This publication is an umbrella review synthesizing evidence from 17 meta-analyses and 52 randomized clinical trials comparing chemotherapy, targeted therapies (TT), and immune checkpoint inhibitors (ICI) in advanced triple-negative breast cancer (aTNBC).
Key findings:
- Progression-free survival (PFS)
Both targeted therapies and immune checkpoint inhibitors improved PFS versus chemotherapy:
- ICI: HR 0.81 (95% CI 0.69–0.94)
- TT: HR 0.68 (95% CI 0.62–0.74)
- Overall survival (OS)
Targeted therapies improved OS versus chemotherapy:
- TT: HR 0.77 (95% CI 0.68–0.88)
The abstract does not report a statistically significant OS benefit for ICI versus chemotherapy.
- Targeted therapy subgroup
Sacituzumab govitecan (monotherapy) and trilaciclib plus chemotherapy were particularly favorable:
- Sacituzumab govitecan:
- PFS: HR 0.41 (95% CI 0.30–0.56)
- OS: HR 0.48 (95% CI 0.33–0.70)
- Trilaciclib + chemotherapy:
- PFS: HR 0.62 (95% CI 0.46–0.86)
- OS: HR 0.41 (95% CI 0.28–0.59)
Conclusions for practice:
- Compared with chemotherapy alone, both targeted therapies and immune checkpoint inhibitors provide PFS benefit in aTNBC, with targeted therapies also conferring an OS advantage.
- Within targeted options, sacituzumab govitecan monotherapy and trilaciclib plus chemotherapy show the most substantial survival gains and are supported as preferred first-line choices in eligible aTNBC patients.
- The methodological quality of the umbrella review is rated high using AMSTAR 2, credibility classification, and GRADE, and the work adheres to PRISMA and is registered in PROSPERO.