Neoadjuvant chemotherapy with angiogenesis inhibitor in early-stage breast cancer: a systematic review and meta-analysis

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Abstract

BACKGROUND: Breast cancer, as a prevalent malignant tumor among women worldwide, has its malignant progression closely linked to angiogenesis mechanisms. Research indicates that combining anti-angiogenic drugs can promote tumor vascular normalization, thereby improving the delivery of chemotherapeutic agents and reversing the drug-resistant microenvironment. Some clinical studies have confirmed that such combination regimens can enhance pathological response rates (pCR). This paper aims to systematically evaluate the clinical value of angiogenesis inhibitors in neoadjuvant chemotherapy (NACT) for breast cancer and provide evidence-based guidance to optimize treatment strategies. METHODS: We systematically searched the PubMed and Web of Science databases up to July 16, 2025, to identify randomized controlled trials (RCTs) comparing angiogenesis inhibitor-based NACT regimens with angiogenesis inhibitor-free regimens in breast cancer patients. Using random effects models, we calculated pooled odds ratios and hazard ratios with 95% confidence intervals for pCR, disease-free survival (DFS), overall survival (OS), objective response rate (ORR), and adverse events (AEs). RESULTS: This analysis included 10 RCTs (8,069 patients). The results showed that NACT containing angiogenesis inhibitors significantly increased the pCR rate (22.59% vs. 29.88%). Subgroup analysis indicated no statistically significant improvement in pCR among hormone receptor-positive patients, whereas in triple-negative breast cancer (TNBC), the pCR rate was significantly elevated (32.42% vs. 42.46%). Regarding survival outcomes, no significant differences were observed in either DFS or OS. CONCLUSIONS: The combination of bevacizumab with NACT can improve the pCR rate, with this effect being particularly pronounced in TNBC. However, current research has not yet reached a consensus on whether it can improve OS, and there remains a lack of clear biomarkers for predicting treatment efficacy. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261411787.

Abstract as published, via PubMed.