Meta Analysis Of The Efficacy And Safety Of Sequential Chemotherapy Of Anthracyclines And Taxanes In Neoadjuvant Therapy For Breast Cancer

Objective:To investigate the effect of sequential chemotherapy of anthracyclines and taxanes on the efficacy and longterm survival of neoadjuvant therapy for breast cancer by meta analysis.Methods:Cochrane Library,Embase,Pub Med,China knowledge Network,Wan-fang Database and Vip were searched for the period from the establishment of the database to December 2020.In the neoadjuvant therapy of breast cancer,the clinical studies of sequential or targeted drugs.The two researchers independently evaluated the quality and extracted data from studies that met the inclusion criteria.The data were analyzed by Meta using Rev Man 5.3 software.The ratios of p CR rate,5-year disease-free survival rate(5y-DFS)and 5-year overall survival rate(5y-OS)after neoadjuvant therapy were compared with OR,to evaluate the effect of sequential anthracycline and taxane chemotherapy on the efficacy and long-term survival of breast cancer neoadjuvant therapy.The Cochrane collaboration network offset risk assessment tool was used for quality evaluation,and Q-test and I~2 were used to calculate the heterogeneity among the studies.Main end point:pathological complete remission rate(p CR).Secondary study endpoints:5-year disease-free survival rate(5y-DFS),5-year overall survival rate(5y-OS),and incidence of adverse events(AEs).Results:A total of 7 clinical studies were included,all of which were randomized controlled trials(RCTs),including 4 phase II clinical trials and 3 phase III clinical trials,involving a total of 1555 breast cancer patients.The results suggested that in the neoadjuvant therapy of breast cancer,the PCR rate of taxane sequential anthracycline group was 23.4%,and that of anthracycline sequential taxane group was 20.5%,and the difference was not statistically significant(OR=1.19,95%CI:0.92-1.54,I2=0%,P=0.18).In terms of long-term survival,the 5y-DFS of taxane sequential anthracycline group was 22.3%,and the 5y-DFS of anthracycline sequential taxane group was 18.9%,and the difference was not statistically significant(HR=0.77,95%CI:0.54-1.10,P=0.15).The 5y-OS of the two groups were 26.3%VS 24.7%,and the difference was not statistically significant(HR=0.72,95%CI:0.46-1.13,P=0.15).In terms of adverse reactions,the sequence of anthracycline and taxane chemotherapy for breast cancer neoadjuvant treatment had no significant effect on neutropenia,fever-related neutropenia,neurotoxicity,treatment-related death,infection,anemia,nausea,allergic reaction,dose adjustment,diarrhea,fatigue,constipation and so on.Conclusion:The sequential order of anthracycline and taxane chemotherapy has no significant effect on the p CR rate,5y-DFS and 5y-OS of neoadjuvant treatment for breast cancer,and the incidence of adverse events is similar.