Zhang J, Yu Y, Lin Y, Kang S, Lv X, Liu Y, Lin J, Wang J, Song C. Efficacy and safety of neoadjuvant therapy for HER2-positive early breast cancer: a network meta-analysis.
Ther Adv Med Oncol 2021;
13:17588359211006948. [PMID:
33868462 PMCID:
PMC8020239 DOI:
10.1177/17588359211006948]
[Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/08/2021] [Indexed: 12/27/2022] Open
Abstract
Aims:
Currently, there are many approaches available for neoadjuvant therapy for
human epidermal growth factor receptor 2 (HER2)-positive breast cancer that
improve therapeutic efficacy but are also controversial. We conducted a
two-step Bayesian network meta-analysis (NMA) to compare odds ratios (ORs)
for pathologic complete response (PCR) and safety endpoints.
Methods:
The Cochrane Central Register of Controlled Trials, PubMed, Embase, and
online abstracts from the American Society of Clinical Oncology and San
Antonio Breast Cancer Symposium were searched comprehensively and
systematically. Phase II/III randomised clinical trials for targeted therapy
in at least one arm were included.
Results:
A total of 9779 published manuscripts were identified, and 36 studies
including 10,379 patients were finally included in our analysis. The NMA of
PCR showed that dual-target therapy is better than single-target therapy and
combination chemotherapy is better than monochemotherapy. However,
anthracycline did not bring extra benefits, whether combined with
dual-target therapy or single-target therapy. On the other hand, the
addition of endocrine therapy in the HER2-positive, hormone receptor
(HR)-positive subgroup might have additional beneficial effects but without
significant statistical difference. By performing a conjoint analysis of the
PCR rate and safety endpoints, we found that ‘trastuzumab plus pertuzumab’
and ‘T-DM1 containing regimens’ were well balanced in terms of efficacy and
toxicity in all target regimens.
Conclusion:
In summary, trastuzumab plus pertuzumab-based dual-target therapy with
combination chemotherapy regimens showed the highest efficacy of all
optional regimens. They also achieved the best balance between efficacy and
toxicity. As our study showed that anthracycline could be replaced by
carboplatin, we strongly recommended TCbHP as the preferred choice for
neoadjuvant treatment of HER2-positive breast cancer. We also look forward
to the potential value of T-DM1 in improving outcomes, which needs further
study in future trials.
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