同源重组缺陷可预测早期三阴性乳腺癌患者对铂类新辅助化疗的反应：一项系统评价和荟萃分析。
Homologous recombination deficiency predicts the response to platinum-based neoadjuvant chemotherapy in early-stage triple-negative breast cancer patients: a systematic review and meta-analysis.
作者信息
Zhang Liulu, Chen Yuanqi, Cheng Min-Yi, Zhuang Xiaosheng, Zou Jiachen, Wei Dannuo, Lin Ying-Yi, Zhang Yi, Wang Kun
机构信息
Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Cell and Molecular Biology, School of Life Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
出版信息
Ther Adv Med Oncol. 2022 May 7;14:17588359221096253. doi: 10.1177/17588359221096253. eCollection 2022.
BACKGROUND
Recent studies have shown that homologous recombination deficiency (HRD) may be correlated with the pathological complete response (pCR) rate. This meta-analysis aimed to determine the predictive value of HRD for the pCR rate in patients with triple-negative breast cancer (TNBC) receiving platinum-based neoadjuvant chemotherapy (NCT).
METHODS
Published articles were searched in the PubMed, Embase, Medline, Web of Science, and Cochrane databases up to 1 June 2021, and studies reporting the pCR rate for HRD carriers on platinum-based NCT were selected. Odds ratios (ORs) with 95% confidence intervals (CIs) were determined for the pCR rate, clinical response rate, and Grade 3 or higher adverse events (AEs) using the random-effects model. Bias risk was evaluated using the Cochrane Collaboration tool (PROSPERO, registration number CRD42021249874).
RESULTS
Seven studies were eligible. The results showed that HRD carriers had higher pCR rates than non-HRD carriers across all treatment arms (OR = 3.84, 95% CI = [1.93, 7.64], = 0.0001). Among HRD carriers, the pCR rate was higher in patients on platinum-based NCT than in those without platinum exposure (OR = 1.95, 95% CI = [1.17, 3.23], = 0.01). We did not observe marked pCR improvements in non-HRD carriers. Among HRD carriers, the pCR rates in the mutant and wild-type breast cancer susceptibility gene (BRCA) groups did not differ significantly (OR = 2.00, 95% CI = [0.77, 5.23], = 0.16), but HRD carriers with wild-type BRCA had a significant advantage over non-HRD carriers on platinum-based NCT (OR = 3.64, 95% CI = [1.83, 7.21], = 0.0002).
CONCLUSION
HRD is an effective predictor of increased pCR rates in platinum-based NCT, especially in wild-type BRCA patients. Adding platinum to NCT for non-HRD carriers can increase the incidence of AEs but may not improve the therapeutic effect.
背景
近期研究表明，同源重组缺陷（HRD）可能与病理完全缓解（pCR）率相关。本荟萃分析旨在确定HRD对接受铂类新辅助化疗（NCT）的三阴性乳腺癌（TNBC）患者pCR率的预测价值。
方法
截至2021年6月1日，在PubMed、Embase、Medline、Web of Science和Cochrane数据库中检索已发表的文章，并选择报告铂类NCT中HRD携带者pCR率的研究。使用随机效应模型确定pCR率、临床缓解率和3级或更高等级不良事件（AE）的比值比（OR）及95%置信区间（CI）。使用Cochrane协作工具（PROSPERO，注册号CRD42021249874）评估偏倚风险。
结果
七项研究符合条件。结果显示，在所有治疗组中，HRD携带者的pCR率高于非HRD携带者（OR = 3.84，95%CI = [1.93, 7.64]，P = 0.0001）。在HRD携带者中，接受铂类NCT的患者的pCR率高于未接受铂类治疗的患者（OR = 1.95，95%CI = [1.17, 3.23]，P = 0.01）。我们未观察到非HRD携带者的pCR有明显改善。在HRD携带者中，突变型和野生型乳腺癌易感基因（BRCA）组的pCR率无显著差异（OR = 2.00，95%CI = [0.77, 5.23]，P = 0.16），但野生型BRCA的HRD携带者在铂类NCT上比非HRD携带者具有显著优势（OR = 3.64，95%CI = [1.83, 7.21]，P = 0.0002）。
结论
HRD是铂类NCT中pCR率升高的有效预测指标，尤其是在野生型BRCA患者中。对非HRD携带者的NCT添加铂类可增加AE的发生率，但可能不会改善治疗效果。
Zotero 插件