Adding a platinum agent to neoadjuvant chemotherapy for triple-negative breast cancer: the end of the debate

We present an update of our previous meta-analysis of RCTs evaluating the survival benefit associated with the use of platinum-based neoadjuvant chemotherapy in TNBC, with a final literature and conference proceedings search strategy up to 20 September 2021. HRs and 95% CI were calculated for the effect of platinum-based versus platinum-free neoadjuvant chemotherapy in terms of EFS and OS. Six RCTs reported on EFS (n = 1681 patients) and five on OS (n = 1557 patients). Among the 1681 included patients, 848 (50.4%) received platinum-based chemotherapy and 833 (49.6%) received platinum-free chemotherapy. All RCTs but one5 used carboplatin as platinum agent. Median follow-up of the included trials ranged between 47 and 67 months. As compared with platinum-free regimens, platinum-based neoadjuvant chemotherapy was associated with a significant increased EFS (HR 0.70, 95% CI 0.56-0.89) (Figure 1A) and a non-significant 18% reduction in the risk of death (HR 0.82, 95% CI 0.64-1.04) (Figure 1B). The sensitivity analyses, conducted by recalculating the pooled HR after the exclusion of each individual study at a time, demonstrated a stability of the pooled estimates