Nigerian medical journal : journal of the Nigeria Medical Association · 2026
Neoadjuvant Chemotherapy Response in Breast Cancer among Nigerian Women: A Systematic Review and Meta-Analysis (2000-2025).
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Muktar Umar, Agbo Stephen P, Bashir Bello M, Sani Hamza, Bello Usman, Sanusi Asmau, Tukur Yusuf, Tukur Aliyu, Mohammed Kabir, Abdullahi Buhari Kaoje, Nuhu Abdullahi Koko, Ningi Adamu
Аннотация
BACKGROUND: Neoadjuvant chemotherapy (NACT) is increasingly employed for locally advanced breast cancer in Nigeria, but treatment outcomes remain heterogeneous and often uncertain relative to global standards.
METHODOLOGY: We systematically reviewed Nigerian studies on NACT outcomes using PubMed, Embase, Scopus, Web of Science, AJOL, and grey literature through September 2025. Eligible studies included women receiving NACT who reported an objective response rate (ORR) or a pathologic complete response (pCR). Quality was assessed using ROBINS-I or RoB-2, and certainty was rated using GRADE. Pooled estimates were generated with random-effects (DerSimonian-Laird) models.
RESULTS: Eleven studies (n = 629 women) met the inclusion criteria. Early anthracycline-based cohorts showed ORR = 51-93% with rare pCR. Contemporary anthracycline-taxane regimens achieved pCR ≈ 20%, the highest in HER2-positive and triple-negative disease. Pooled ORR = 66% (95% CI: 55-76%; I2= 46%) and pooled pCR = 20% (95% CI: 15-25%; I2= 39%). Excluding a non-standard single-agent trial raised pCR to 21%. The HER2-targeted ARETTA trial achieved pCR = 53%, approximating global benchmarks. Although one comparative study showed lower Nigerian pCR (5% vs 27% U.S.), survival appeared similar among patients completing multimodality therapy (observational finding). Certainty of evidence was rated low-to-moderate (GRADE).
CONCLUSIONS: NACT in Nigeria achieves consistent clinical downstaging but modest pCR outside HER2-targeted settings. Expanding access to biomarker testing, taxanes, trastuzumab (including biosimilars), and ensuring therapy completion are essential to close the global outcome gap.
METHODOLOGY: We systematically reviewed Nigerian studies on NACT outcomes using PubMed, Embase, Scopus, Web of Science, AJOL, and grey literature through September 2025. Eligible studies included women receiving NACT who reported an objective response rate (ORR) or a pathologic complete response (pCR). Quality was assessed using ROBINS-I or RoB-2, and certainty was rated using GRADE. Pooled estimates were generated with random-effects (DerSimonian-Laird) models.
RESULTS: Eleven studies (n = 629 women) met the inclusion criteria. Early anthracycline-based cohorts showed ORR = 51-93% with rare pCR. Contemporary anthracycline-taxane regimens achieved pCR ≈ 20%, the highest in HER2-positive and triple-negative disease. Pooled ORR = 66% (95% CI: 55-76%; I2= 46%) and pooled pCR = 20% (95% CI: 15-25%; I2= 39%). Excluding a non-standard single-agent trial raised pCR to 21%. The HER2-targeted ARETTA trial achieved pCR = 53%, approximating global benchmarks. Although one comparative study showed lower Nigerian pCR (5% vs 27% U.S.), survival appeared similar among patients completing multimodality therapy (observational finding). Certainty of evidence was rated low-to-moderate (GRADE).
CONCLUSIONS: NACT in Nigeria achieves consistent clinical downstaging but modest pCR outside HER2-targeted settings. Expanding access to biomarker testing, taxanes, trastuzumab (including biosimilars), and ensuring therapy completion are essential to close the global outcome gap.