Liao Hao, Pei Wendi, Zhong Jianxin, Shao Bin, Liu Xiaoran, Liu Yaxin, Zhang Jiayang, Rugo Hope S, Li Huiping
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Breast Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Center for Reproductive Medicine, Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology and Key Laboratory of Assisted Reproduction, Department of Obstetrics and Gynecology, Ministry of Education, Peking University Third Hospital, Beijing, China.
Front Pharmacol. 2022 May 30;13:886954. doi: 10.3389/fphar.2022.886954. eCollection 2022.
To identify the optimal initial 5 years of adjuvant endocrine therapy for hormone receptor-positive postmenopausal early breast cancer (EBC) patients. We conducted a systematic search of the PubMed, Web of Science, and EMBASE to obtain relevant studies published between January 2000 and January 2022. Randomized clinical trials assessing the efficacy and safety of initial 5 years of adjuvant endocrine therapy were included. The primary outcomes were disease-free survival and overall survival and the secondary outcome was severe adverse effects (SAEs). A Bayesian network meta-analysis was carried out to indirectly compare all regimens and the value of surface under the cumulative ranking curve (SUCRA) was used to obtain rankings. Eleven studies with 49,987 subjects were included. For DFS, exemestane (EXE) [hazard ratio (HR) 0.91, 95% confidence interval (95%CI) 0.87-0.96], anastrozole (ANA) (0.94, 0.90-0.97), letrozole (LET) (0.93, 0.89-0.97), tamoxifen (TAM) followed by EXE (0.91, 0.87-0.96), and TAM followed by ANA (0.92, 0.87-0.98) were more favorable than TAM, with TAM followed by EXE ranking as the first of SUCRA. For OS, only TAM followed by ANA showed significant superiority than TAM (HR 0.91, 95%CI 0.86-0.97) and ranked as the first of SUCRA. For SAEs, EXE (HR 1.72, 95%CI 1.04-2.98), ANA (1.58, 1.03-2.43), and LET (1.63, 1.02-2.57) showed greater associations with bone fracture than TAM. However, no significant difference in the incidences of cardiac events, thromboembolic events, and cerebrovascular events was found among all comparisons. The sequential use of aromatase inhibitors, which has the best curative effects and relatively mild side effects, may be the optimal treatment mode for hormone receptor-positive postmenopausal EBC patients. In addition, the three kinds of aromatase inhibitors achieved roughly equal efficacy, but caused different types of SAEs. [website], identifier [registration number].
为确定激素受体阳性绝经后早期乳腺癌（EBC）患者辅助内分泌治疗的最佳初始5年方案。我们对PubMed、科学网和EMBASE进行了系统检索，以获取2000年1月至2022年1月发表的相关研究。纳入评估初始5年辅助内分泌治疗疗效和安全性的随机临床试验。主要结局为无病生存期和总生存期，次要结局为严重不良反应（SAE）。进行贝叶斯网络荟萃分析以间接比较所有方案，并使用累积排序曲线下面积（SUCRA）值来获得排名。纳入了11项研究，共49987名受试者。对于无病生存期，依西美坦（EXE）[风险比（HR）0.91，95%置信区间（95%CI）0.87 - 0.96]、阿那曲唑（ANA）（0.94，0.90 - 0.97）、来曲唑（LET）（0.93，0.89 - 0.97）、他莫昔芬（TAM）序贯EXE（0.91，0.87 - 0.96）以及TAM序贯ANA（0.92，0.87 - 0.98）比TAM更具优势，其中TAM序贯EXE的SUCRA排名第一。对于总生存期，只有TAM序贯ANA显示出比TAM有显著优势（HR 0.91，95%CI 0.86 - 0.97）且SUCRA排名第一。对于严重不良反应，EXE（HR 1.72，95%CI 1.04 - 2.98）、ANA（1.58，1.03 - 2.43）和LET（1.63，1.02 - 2.57）与骨折的关联比TAM更强。然而，在所有比较中，心脏事件、血栓栓塞事件和脑血管事件的发生率没有显著差异。芳香化酶抑制剂的序贯使用具有最佳疗效且副作用相对较轻，可能是激素受体阳性绝经后EBC患者的最佳治疗模式。此外，三种芳香化酶抑制剂疗效大致相当，但会引起不同类型的严重不良反应。[网站]，标识符[注册号]
