Dose-Dense Adjuvant Treatments For Women With High-Risk Breast Cancer:a Network Meta-Analysis

Objective To compare these dose-dense adjuvant treatments for women with high-risk breast cancer with Bayesian network meta-analysis.Methods we searched the Cochrane Library、MBASE、PubMed、 Clinical Trials.gov were systematically reviewed for randomized-controlled trials comparing the dense-dose chemotherapy of high-risk breast cancer before February,2015. we estimated relative hazard ratios of death between different therapies by combining hazard ratios of death included trials,For a given outcome, the using of the Bayesian models in WinBUGS version 1.4.3 with SUCRA statistical methodologies reflected the average advantages of each treatment compared whith other treatment options for each program rankings.Results 10 eligible articles reporting 14 trials were included and a total of 20309 patients in 14 different treatment arms were assessed. The surface under the cumulative ranking probability curve indicated that dose dense fluorouracil plus epirubicin or doxorubicin plus cyclophosphamide for 6 cycles regimen ddFEC(6)/ddFAC(6) (SUCRA=0.815)had the highest probability of being the best treatment arms in terms of overall survival, followed docetaxel plus cyclophosphamide for 4cycles regimen TC(4) (SUCRA=0.803), sequential administration of each of three cycles of dose dense epirubicin/paclitaxel/ cyclophosphamide ddA-C-T(3) (SUCRA=0.794) sequential administration of each of three cycles of dose dense epirubicin/paclitaxel/cyclophosphamide plus filgrastim (ddA-T-C+EPO(3) (SUCRA=0.79).Network meta-analysis showed ddFEC(6)/ddFAC(6), TC(4), ddA-T-C(3), and ddA-T-C+EPO(3)had statistically significantly more overall survival benefits than sequential administration of 3 weeks for four cycles epirubicin/paclitaxel/ cyclophosphamide A-T-C(4), Compared with A-T-C(4), the HR for death was 0.39 (95% CI 0.21-0.67) for ddFEC(6)/ddFAC(6),0.39 (95% CI 0.25-0.6) for TC(4),0.4 (95%CI 0.28-0.55) for ddA-T-C(3),and 0.39 (95% CI 0.23-0.62) for ddA-C-T+EPO(3).Conclusions According to the Bayesian models computing results,our study indicates that ddFEC(6)/ddFAC(6)may be the optimum adjuvant treatment for women with high-risk breast cancer.