Shen Guoshuang, Zhao Fuxing, Huo Xingfa, Ren Dengfeng, Du Feng, Zheng Fangchao, Zhao Jiuda
Breast Disease Diagnosis and Treatment Center of Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China.
Key Laboratory of Carcinogenesis and Translational Research, The VIPII Gastrointestinal Cancer Division of Medical Department, Peking University Cancer Hospital and Institute, Beijing, China.
Front Oncol. 2021 Jul 23;11:632357. doi: 10.3389/fonc.2021.632357. eCollection 2021.
This meta-analysis aimed to better elucidate the predictive value of human epidermal growth factor receptor 2 (HER2)-enriched subtype of pathological complete response (pCR) rate within HER2-positive breast cancer patients receiving neoadjuvant treatment.
We identified prospective trials that evaluated the correlation between an HER2-enriched subtype and pCR rate in HER2-positive breast cancer. Pooled odds ratio (OR) values with 95% confidence intervals (CIs) were computed.
Fifteen studies comprising 2,190 patients met the inclusion criteria. The HER2-enriched subtype was associated with increased odds of achieving a pCR (OR = 4.12, 95% CI = 3.38 to 5.03, < 0.001) in patients overall. Moreover, it was correlated with improved pCR when single or dual HER2-targeted agent-based therapy was employed (OR = 3.36, 95% CI = 2.25 to 5.02, < 0.001; OR = 4.66, 95% CI = 3.56 to 6.10, < 0.001, respectively), but not when HER2-targeted agent-free chemotherapy was used (OR = 2.52, 95% CI = 0.98 to 6.49, P = 0.05). Moreover, an HER2-enriched subtype predicted higher pCR rates irrespective of HER2-targeted agents (trastuzumab, lapatinib, pertuzumab, or T-DM1); chemotherapy agents (taxane-based, or anthracyclines plus taxane-based); endocrine therapy and hormone receptor [all the differences were statistically significant ( all ≤ 0.001)].
The HER2-enriched subtype can more effectively and specifically predict pCR for HER2-targeted agent-based neoadjuvant treatment, irrespective of the number (single or dual) or category of HER2-targeted agent, including chemotherapy and endocrine therapy, or hormone receptor in cases of HER2-positive breast cancer.
本荟萃分析旨在更好地阐明在接受新辅助治疗的人表皮生长因子受体2（HER2）阳性乳腺癌患者中，HER2富集亚型对病理完全缓解（pCR）率的预测价值。
我们确定了评估HER2阳性乳腺癌中HER2富集亚型与pCR率之间相关性的前瞻性试验。计算了合并比值比（OR）值及95%置信区间（CI）。
15项研究共纳入2190例患者，符合纳入标准。总体而言，HER2富集亚型与实现pCR的几率增加相关（OR = 4.12，95% CI = 3.38至5.03，P < 0.001）。此外，当采用基于单药或双药HER2靶向治疗时，它与pCR改善相关（OR分别为3.36，95% CI = 2.25至5.02，P < 0.001；OR = 4.66，95% CI = 3.56至6.10，P < 0.001），但在未使用HER2靶向药物的化疗中则不然（OR = 2.52，95% CI = 0.98至6.49，P = 0.05）。此外，无论HER2靶向药物（曲妥珠单抗、拉帕替尼、帕妥珠单抗或T-DM1）、化疗药物（紫杉烷类或蒽环类加紫杉烷类）、内分泌治疗及激素受体情况如何，HER2富集亚型均预测较高的pCR率[所有差异均具有统计学意义（所有P ≤ 0.001）]。
HER2富集亚型能够更有效且特异性地预测基于HER2靶向药物的新辅助治疗的pCR，无论HER2靶向药物的数量（单药或双药）或类别如何，包括化疗、内分泌治疗，或HER2阳性乳腺癌中的激素受体情况。
