Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast XXXX : A Systematic Review and Network Meta-analysis.

@entity1 @entity137 @entity0 @entity902 @entity5 @entity5948 @entity786 @entity3907 @entity1349 @entity1499 @entity1205 @entity1487
Importance: Different adjuvant chemotherapy regimens are available for @entity0 . Because conventional meta-analysis does not allow comparing all regimens, we performed a network meta-analysis to identify the most effective adjuvant chemotherapy regimen. Objective: To find the most effective adjuvant therapy regimen for @entity0 . Data Sources: We searched MEDLINE, Embase, and the Cochrane Library for articles published before June 2015; the American Society of Clinical Oncology annual meeting abstracts from January 1983 through December 2014; and the American Association for @entity5 Research annual meeting abstracts from January 1916 through December 2014. Additionally, we manually searched bibliographies for related references. Study Selection: We included randomized clinical trials of adjuvant treatments for @entity0 that compared 2 or more of the following: no adjuvant chemotherapy; sequential @entity5948 - @entity786 and @entity3907 (AC-T); concurrent @entity5948 - @entity786 and @entity3907 (ACT); @entity5948 - @entity786 without @entity3907 (AC); @entity1205 and @entity786 (TC); @entity786 , @entity1499 , and @entity1487 (CMF); and @entity902 -containing regimens. Data Extraction and Synthesis: We followed the PRISMA guidelines. Two investigators independently selected the articles and extracted information. Disagreements were resolved by discussion with another author. Quality was assessed by Cochrane risk-of-bias method. Data were pooled using random-effects models. Main Outcomes and Measures: We used network meta-analysis to test the most effective adjuvant therapy regimen in terms of @entity1349 ( @entity1349 ) by comparing regimens listed in the National @entity5 Network guidelines and @entity902 -containing regimens. Results: We identified 24 trials. The TC and @entity902 -containing regimens had @entity1349 benefit similar to that of sequential AC-T (TC hazard ratio [HR], 0.93; 95% CI, 0.62-1.40; and @entity902 HR, 0.93; 95% CI, 0.66-1.31). @entity1 treated with CMF or AC had significantly worse @entity1349 than those treated with sequential AC-T (CMF HR, 1.56; 95% CI, 1.32-1.85; and AC HR, 1.22; 95% CI, 1.10-1.37). @entity902 -containing regimens tended to be more toxic than sequential AC-T. The @entity137 of TC was similar to or less than that of sequential AC-T. Meta-regression analysis showed that hormone receptor status did not impact the HRs for @entity1349 for any regimen. Conclusions and Relevance: Sequential AC-T is likely to be the most effective adjuvant therapy regimen for @entity0 regardless of hormone receptor status.
