抗HER2药物联合化疗用于HER2阳性转移性乳腺癌患者的疗效和安全性：一项网状Meta分析
Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis.
作者信息
Zhang Xiaohui, Leng Junsheng, Zhou Yidong, Mao Feng, Lin Yan, Shen Songjie, Sun Qiang
机构信息
Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, China.
Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, China.
出版信息
Front Oncol. 2021 Aug 19;11:731210. doi: 10.3389/fonc.2021.731210. eCollection 2021.
BACKGROUND
The presence of anti-HER2 agents, such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1), significantly improved the prognosis of metastatic HER2-positive (HER2+) breast cancers (BC). However, drug resistance and disease progression are still common. In order to further improve the treatment efficacy, new clinical trials about anti-HER2 agents in combination with chemotherapy are growing rapidly. We conducted the network meta-analysis to synthesize evidences of clinical trials to identify the best therapy for metastatic HER2+ BC.
METHODS
A systematic search of randomized controlled trials regarding anti-HER2 agents in combination with chemotherapy for advanced or metastatic breast cancers up to May 2020 was conducted in Embase, PubMed, and the Cochrane Library. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), objective response rate (ORR), and safety. Bayesian network meta-analysis was conducted to synthesize the results and rank the therapies.
RESULTS
Twenty-six studies, including 16 studies for first-line treatments and 10 studies for second- or later-line treatments were included in the network meta-analysis. For first-line studies, the THP (taxanes + trastuzumab + pertuzumab) regimen exhibited the highest probability to be the optimal treatment in all efficacy outcomes and moderate safety. For second- or later-line studies, the T-DM1 and XHTuC (capecitabine + trastuzumab + tucatinib) regimens ranked top two in all efficacy outcomes according to the surface under the cumulative ranking (SUCRA) results. T-DM1 ranked first in PFS and OS whereas XHTuC ranked first in ORR. The safety outcomes of T-DM1 and XHTuC were acceptable.
CONCLUSIONS
THP was still the optimal first-line treatment for metastatic HER2+ BC. T-DM1 and XHTuC were recommended for second-line treatments.
SYSTEMATIC REVIEW REGISTRATION
INPLASY.com, identifier (INPLASY202090086).
背景
抗HER2药物，如曲妥珠单抗、帕妥珠单抗和曲妥珠单抗恩美曲妥珠单抗（T-DM1）的出现，显著改善了转移性HER2阳性（HER2+）乳腺癌（BC）的预后。然而，耐药性和疾病进展仍然很常见。为了进一步提高治疗效果，关于抗HER2药物联合化疗的新临床试验正在迅速增加。我们进行了网络荟萃分析，以综合临床试验证据，确定转移性HER2+ BC的最佳治疗方案。
方法
在Embase、PubMed和Cochrane图书馆中对截至2020年5月的关于抗HER2药物联合化疗治疗晚期或转移性乳腺癌的随机对照试验进行了系统检索。主要结局是无进展生存期（PFS）。次要结局是总生存期（OS）、客观缓解率（ORR）和安全性。进行贝叶斯网络荟萃分析以综合结果并对治疗方案进行排名。
结果
网络荟萃分析纳入了26项研究，其中包括16项一线治疗研究和10项二线或后续治疗研究。对于一线研究，THP（紫杉烷类+曲妥珠单抗+帕妥珠单抗）方案在所有疗效结局中显示出成为最佳治疗方案的最高概率，且安全性中等。对于二线或后续治疗研究，根据累积排名曲线下面积（SUCRA）结果，T-DM1和XHTuC（卡培他滨+曲妥珠单抗+图卡替尼）方案在所有疗效结局中排名前两位。T-DM1在PFS和OS方面排名第一，而XHTuC在ORR方面排名第一。T-DM1和XHTuC的安全性结局是可接受的。
结论
THP仍然是转移性HER2+ BC的最佳一线治疗方案。推荐T-DM1和XHTuC用于二线治疗。
系统评价注册
INPLASY.com，标识符（INPLASY202090086）。
Zotero 插件