Efficacy and Safety of First-Line Treatment for Advanced Triple- Negative Breast Cancer: A Network Meta-Analysis of Randomized Controlled Trials

Background: Various therapeutic regimens have emerged as first-line treatments for advanced triple-negative breast cancer (TNBC); however,the optimal choice remains uncertain. This study employeda network meta-analysis to comprehensively evaluate the efficacy and safety of different treatment strategies. Methods: A systematic literature search without restrictions was conducted in PubMed, Embase, and the Cochrane Library from inception to November 2, 2025. Manual searches of conference abstracts from American Society of Clinical Oncology, European Society for Medical Oncology, and San Antonio Breast Cancer Symposium (2020-2025) were also performed. Identified randomized controlled trials were analyzed using a network meta-analysis with a random-effects model. Results are expressed as hazard ratios (HR) and odds ratios with 95% confidence intervals (CI). Treatments were ranked by the surface under the cumulative ranking curve (SUCRA), with progression-free survival (PFS) designated as the primary endpoint. Results: A total of 3,279 articles were screened, of which 26 clinical studies involving 8,447 patients with advanced TNBC were included. Bevacizumab combined with capecitabine and vinorelbine demonstrated superior PFS in the entire study population (vs paclitaxel: HR 0.24, 95% CI 0.11–0.49). Despite achieving the highest SUCRA for overall survival, the benefit of bevacizumab plus chemotherapy was not statistically significant (HR 0.44, 95% CI 0.16–1.17). Subgroup analysis indicated that the combination of sacituzumab govitecan (SG) and pembrolizumab achieved the most favorable PFS outcomes among PD-L1 positive patients (SG vs paclitaxel: HR 0.54, 95% CI 0.40–0.75). The paclitaxel plus platinum-based regimen achieves an optimal balance between efficacy and safety. Conclusions: Therapeutic strategies for advanced TNBC should be personalized. The combination of SG and pembrolizumab may offer greater benefit in PD-L1 positive subgroups, while paclitaxel-platinum regimens may represent a relatively balanced option in terms of efficacy and safety, particularly for patients with unknown PD-L1 status.