Morgan Welch Inflammatory Breast Cancer Research Program and Clinic and Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
PLoS One. 2021 Apr 16;16(4):e0250057. doi: 10.1371/journal.pone.0250057. eCollection 2021.
The current use of targeted therapy plus neoadjuvant chemotherapy for inflammatory breast cancer (IBC) is based on data extrapolated from studies in non-IBC. We conducted a systematic review to determine whether neoadjuvant chemotherapy plus targeted therapy results in a higher pathologic complete response (pCR) rate than neoadjuvant chemotherapy alone in patients with IBC.
This systematic review was registered in the PROSPERO register with registration number CRD42018089465. We searched MEDLINE & PubMed, EMBASE, and EBSCO from December 1998 through July 2020. All English-language clinical studies, both randomized and non-randomized, that evaluated neoadjuvant systemic treatment with or without targeted therapy before definitive surgery and reported the pCR results of IBC patients. First reviewer extracted data and assessed the risk of bias using the Risk of Bias In Non-randomized Studies of Interventions tool. Second reviewer confirmed the accuracy. Studies were divided into 3 groups according to systemic treatment: chemotherapy with targeted therapy, chemotherapy alone, and high-dose chemotherapy with hematopoietic stem cell support (HSCS). Of 995 screened studies, 23 with 1,269 IBC patients met the inclusion criteria. For each of the 3 groups of studies, we computed a weighted average of the pCR rates across all studies with confidence interval (CI). The weighted averages (95% CIs) were as follows: chemotherapy with targeted therapy, 31.6% (26.4%-37.3%), chemotherapy alone, 13.0% (10.3%-16.2%), and high-dose chemotherapy with HSCS, 23.0% (18.7%-27.7%). The high pCR by targeted therapy group came from anti-HER2 therapy, 54.4% (44.3%-64.0%). Key limitations of this study included no randomized clinical studies that included only IBC patients.
Neoadjuvant chemotherapy plus targeted therapy is more effective than neoadjuvant chemotherapy alone for IBC patients. These findings support current IBC standard practice in particular the use of anti-HER2 targeted therapy.
目前，针对炎性乳腺癌（IBC）的治疗方法是在非 IBC 研究中得出的靶向治疗联合新辅助化疗。我们进行了一项系统评价，以确定 IBC 患者新辅助化疗联合靶向治疗是否比单纯新辅助化疗有更高的病理完全缓解（pCR）率。
本系统评价在 PROSPERO 注册中心注册，注册号为 CRD42018089465。我们检索了 MEDLINE & PubMed、EMBASE 和 EBSCO 数据库，检索时间为 1998 年 12 月至 2020 年 7 月。所有评估新辅助全身治疗（包括靶向治疗）与单纯新辅助化疗，以及报告 IBC 患者 pCR 结果的前瞻性随机和非随机临床试验，均以英文发表。第一审查员使用非随机干预研究的风险偏倚工具提取数据并评估风险偏倚，第二审查员确认准确性。根据全身治疗方案，将研究分为三组：化疗联合靶向治疗、化疗单独治疗和高剂量化疗联合造血干细胞支持（HSCS）。在 995 项筛选研究中，有 23 项研究共纳入 1269 例 IBC 患者符合纳入标准。对于三组研究，我们在所有研究中计算了每个组别的 pCR 率及其置信区间（CI）的加权平均值。加权平均值（95%CI）如下：化疗联合靶向治疗组为 31.6%（26.4%-37.3%），化疗单独治疗组为 13.0%（10.3%-16.2%），高剂量化疗联合 HSCS 组为 23.0%（18.7%-27.7%）。靶向治疗高 pCR 率来自于抗 HER2 治疗，为 54.4%（44.3%-64.0%）。本研究的主要局限性包括没有仅包括 IBC 患者的随机临床试验。
新辅助化疗联合靶向治疗对 IBC 患者比单纯新辅助化疗更有效。这些发现支持目前 IBC 的标准治疗实践，特别是抗 HER2 靶向治疗的应用。
