Updated Bayesian Network Meta-Analysis of Adjuvant Targeted Treatment Regimens for Early Human Epidermal Growth Factor Receptor-2 Positive Breast Cancer

Xinyan Li; Litong Yao; Mozhi Wang; Mengshen Wang; Xiang Li; Xueting Yu; Jingyi Guo; Haoran Dong; Xiangyu Sun; Yingying Xu

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저자정보: Xinyan Li (The First Affiliated Hospital of China Medical University) Litong Yao (The First Affiliated Hospital of China Medical University) Mozhi Wang (The First Affiliated Hospital of China Medical University) Mengshen Wang (The First Affiliated Hospital of China Medical University) Xiang Li (The First Affiliated Hospital of China Medical University) Xueting Yu (The First Affiliated Hospital of China Medical University) Jingyi Guo (The First Affiliated Hospital of China Medical University) Haoran Dong (The First Affiliated Hospital of China Medical University) Xiangyu Sun (The First Affiliated Hospital of China Medical University) Yingying Xu (The First Affiliated Hospital of China Medical University)

저널정보: 한국유방암학회 Journal of Breast Cancer Journal of Breast Cancer Vol.23 No.4

발행연도: 2020.1

수록면: 410 - 429 (20page)

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Purpose: Combining targeted agents with adjuvant chemotherapy prolongs survival in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients, but also increases the risk of adverse effects. The updated results of 3 randomized controlled trials (RCTs) were reported in 2019. Given the lack of adequate head-to-head pairwise assessment for anti-HER2 agents, network meta-analysis facilitates obtaining more precise inference for evidence-based therapy. Methods: RCTs comparing at least 2 anti-HER2 regimens in an adjuvant setting for HER2- positive early-stage breast cancer (EBC) were included. Hazard ratios for overall survival (OS) and disease free survival (DFS), with respective 95% confidence intervals were pooled for assessment of efficacy. A Bayesian statistical model was used, and odds ratios (ORs) for adverse events (AEs) were used to pool effect sizes. Results: We demonstrated that 1-year trastuzumab plus chemotherapy had increased efficacy compared to shorter or longer treatment duration. The OR of cardiac events gradually increased from 6 months to 1 and 2-year trastuzumab arms, relative to chemotherapy only. Compared to trastuzumab plus chemotherapy, dual HER2-targeting therapies increased DFS, especially for hormone receptor negative patients. Dual anti-HER2 blockade regimens revealed an increased probability of gastrointestinal reactions. As a second agent, pertuzumab showed significantly higher DFS and OS. Conclusion: We conclude that 1-year adjuvant trastuzumab should remain as the standard treatment for HER2-positive EBC patients, as it has greater efficacy and a manageable proportion of AEs. Clinical efficacy can be increased for hormone receptor-negative tumors by including a second HER2-targeted agent to the treatment regimen. For hormone receptor-positive cases with basal disease, it is acceptable to reduce the risk of cardiotoxicity by shortening the duration of trastuzumab.

#Breast neoplasms #Drug therapy #ERBB2 protein #human #Network meta-analysis #Trastuzumab

참고문헌 (30)

참고문헌 신청

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Slamon DJ / 1989 / Studies of the HER-2/neu proto-oncogene in human breast and ovarian cancer / Science 244:707~712

Pathmanathan N / 2016 / Human epidermal growth factor receptor 2 status of breast cancer patients in Asia: results from a large, multicountry study / Asia Pac J Clin Oncol 12:369~379

Perez EA / 2014 / Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer : planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831 / J Clin Oncol 32:3744~3752

Slamon D / 2011 / Adjuvant trastuzumab in HER2-positive breast cancer / N Engl J Med 365:1273~1283

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