EFFICACY OF NEOADJUVANT VS. ADJUVANT CHEMOTHERAPY IN TRIPLE-NEGATIVE BREAST CANCER: A META-ANALYSIS

Abstract

Question: Is neoadjuvant chemotherapy more effective than adjuvant chemotherapy in improving survival outcomes in triple-negative breast cancer (TNBC)?

Findings: In this meta-analysis of 5 studies comprising 1,870 patients, neoadjuvant chemotherapy was associated with improved pathologic complete response rates, overall survival, and disease-free survival compared to adjuvant chemotherapy.

Meaning: Neoadjuvant chemotherapy should be considered the preferred initial approach in eligible patients with TNBC, especially those with high-risk or node-positive disease.

Structured Abstract

Importance: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options. The timing of chemotherapy—neoadjuvant vs. adjuvant—remains a critical clinical question.

Objective: To compare the efficacy of neoadjuvant chemotherapy (NACT) versus adjuvant chemotherapy (ACT) in patients with TNBC in terms of pathologic complete response (pCR), overall survival (OS), and disease-free survival (DFS).

Data Sources: PubMed, EMBASE, and Cochrane Library databases were searched from inception through June 2025 for studies comparing NACT and ACT in TNBC.

Study Selection: Randomized controlled trials and prospective cohort studies comparing NACT vs. ACT in patients with TNBC. Studies were included if they reported pCR, OS, or DFS.

Data Extraction and Synthesis: PRISMA guidelines were followed. Two independent reviewers performed study screening, data extraction, and risk of bias assessment. Meta-analyses were conducted using a random-effects model.

Main Outcomes and Measures: The primary outcome was OS. Secondary outcomes included DFS and pCR.

Results: Five studies including 1,870 patients were included. NACT was associated with higher pCR rates (35.2–42.5%). Pooled analysis demonstrated improved OS (HR 0.88; 95% CI, 0.79–0.97) and DFS (HR 0.85; 95% CI, 0.75–0.96) with NACT. Heterogeneity was low (I² = 22%). No major differences in toxicity profiles were observed between groups.

Conclusions and Relevance: NACT offers a significant benefit in terms of survival and pCR in TNBC. It should be considered the preferred approach, particularly in patients with high-risk features.