抗HER2药物联合辅助或新辅助化疗治疗早期和局部晚期HER2阳性乳腺癌患者的疗效：一项网状Meta分析
Efficacy of Anti-HER2 Agents in Combination With Adjuvant or Neoadjuvant Chemotherapy for Early and Locally Advanced HER2-Positive Breast Cancer Patients: A Network Meta-Analysis.
作者信息
Debiasi Márcio, Polanczyk Carisi A, Ziegelmann Patrícia, Barrios Carlos, Cao Hongyuan, Dignam James J, Goss Paul, Bychkovsky Brittany, Finkelstein Dianne M, Guindalini Rodrigo S, Filho Paulo, Albuquerque Caroline, Reinert Tomás, de Azambuja Evandro, Olopade Olufunmilayo
机构信息
School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
National Institute for Health Technology Assessment (IATS), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
出版信息
Front Oncol. 2018 May 22;8:156. doi: 10.3389/fonc.2018.00156. eCollection 2018.
BACKGROUND
Several (neo)adjuvant treatments for patients with HER2-positive breast cancer have been compared in different randomized clinical trials. Since it is not feasible to conduct adequate pairwise comparative trials of all these therapeutic options, network meta-analysis offers an opportunity for more detailed inference for evidence-based therapy.
METHODS
Phase II/III randomized clinical trials comparing two or more different (neo)adjuvant treatments for HER2-positive breast cancer patients were included. Relative treatment effects were pooled in two separate network meta-analyses for overall survival (OS) and disease-free survival (DFS).
RESULTS
17 clinical trials met our eligibility criteria. Two different networks of trials were created based on the availability of the outcomes: OS network (15 trials: 37,837 patients); and DFS network (17 trials: 40,992 patients). Two studies-the ExteNET and the NeoSphere trials-were included only in this DFS network because OS data have not yet been reported. The concept of the dual anti-HER2 blockade proved to be the best option in terms of OS and DFS. Chemotherapy (CT) plus trastuzumab (T) and lapatinib (L) and CT + T + Pertuzumab (P) are probably the best treatment options in terms of OS, with 62.47% and 22.06%, respectively. In the DFS network, CT + T + Neratinib (N) was the best treatment option with 50.55%, followed by CT + T + P (26.59%) and CT + T + L (20.62%).
CONCLUSION
This network meta-analysis suggests that dual anti-HER2 blockade with trastuzumab plus either lapatinib or pertuzumab are probably the best treatment options in the (neo)adjuvant setting for HER2-positive breast cancer patients in terms of OS gain. Mature OS results are still expected for the Aphinity trial and for the sequential use of trastuzumab followed by neratinib, the treatment that showed the best performance in terms of DFS in our analysis.
背景
在不同的随机临床试验中，对HER2阳性乳腺癌患者的几种（新）辅助治疗方法进行了比较。由于对所有这些治疗方案进行充分的两两比较试验是不可行的，网络荟萃分析为基于证据的治疗提供了更详细推断的机会。
方法
纳入比较两种或更多不同的HER2阳性乳腺癌患者（新）辅助治疗方法的II/III期随机临床试验。将相对治疗效果汇总到两个单独的网络荟萃分析中，分别用于总生存期（OS）和无病生存期（DFS）。
结果
17项临床试验符合我们的纳入标准。根据结果的可获得性创建了两个不同的试验网络：OS网络（15项试验：37837例患者）；和DFS网络（17项试验：40992例患者）。两项研究——ExteNET试验和NeoSphere试验——仅纳入了该DFS网络，因为尚未报告OS数据。就OS和DFS而言双抗HER2阻断的概念被证明是最佳选择。就OS而言，化疗（CT）加曲妥珠单抗（T）和拉帕替尼（L）以及CT + T +帕妥珠单抗（P）可能是最佳治疗方案，分别为62.47%和22.06%。在DFS网络中，CT + T +来那替尼（N）是最佳治疗方案，为50.55%，其次是CT + T + P（26.59%）和CT + T + L（20.62%）。
结论
该网络荟萃分析表明，就提高OS而言，曲妥珠单抗联合拉帕替尼或帕妥珠单抗进行双抗HER2阻断可能是HER2阳性乳腺癌患者（新）辅助治疗的最佳选择。仍期待Aphinity试验以及曲妥珠单抗序贯来那替尼治疗的成熟OS结果，在我们的分析中该治疗方案在DFS方面表现最佳。
Zotero 插件