Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, China.
Curr Oncol. 2023 Sep 15;30(9):8444-8463. doi: 10.3390/curroncol30090615.
Despite the development of HER2-targeted drugs, achieving favorable outcomes for patients with HR+/HER2+MBC remains challenging. This study utilized Bayesian Network Meta-analysis to compare the efficacy and safety of anti-HER2 combination regimens. The primary analysis focused on progression-free survival (PFS), while secondary analyses included objective response rate, overall survival (OS) and the incidence rate of grade 3/4 adverse events (AEs). A comprehensive search across seven databases identified 25 randomized controlled trials for inclusion in this meta-analysis. For patients eligible for endocrinotherapy, our findings revealed that dual-target combined endocrine therapy, such as Her2-mAb+Her2-mAb+Endo (HR = 0.38; 95%CrI: 0.16-0.88) and Her2-mAb+Her2-tki+Endo (HR = 0.45; 95%CrI: 0.23-0.89), significantly improved PFS compared to endocrine therapy alone. According to the surface under the cumulative ranking curves (SUCRAs), Her2-mAb+Her2-mAb+Endo and Her2-mAb+Her2-tki+Endo ranked highest in terms of PFS and OS, respectively. For patients unsuitable for endocrine therapy, anti-HER2 dual-target combined chemotherapy, such as Her2-mAb+Her2-mAb+Chem (HR = 0.76; 95%CrI: 0.6-0.96) and Her2-mAb+Her2-tki+Chem (HR = 0.48; 95%CrI: 0.29-0.81), demonstrated significant improvements in PFS compared to Her2-mAb+Chem. The results were the same when compared with Her2-tki+Chem. According to the SUCRAs, Her2-mAb+Her2-tki+Chem and Her2-mAb+Her2-mAb+Chem ranked highest for PFS and OS, respectively. Subgroup analyses consistently supported these overall findings, indicating that dual-target therapy was the optimal approach irrespective of treatment line.
尽管已经开发出针对 HER2 的药物，但对于 HR+/HER2+MBC 患者，要获得良好的治疗效果仍然具有挑战性。本研究采用贝叶斯网络荟萃分析比较了抗 HER2 联合方案的疗效和安全性。主要分析侧重于无进展生存期（PFS），次要分析包括客观缓解率、总生存期（OS）和 3/4 级不良事件（AE）的发生率。通过对七个数据库的全面检索，共纳入 25 项随机对照试验进行荟萃分析。对于适合内分泌治疗的患者，我们的研究结果表明，双重靶向联合内分泌治疗，如 Her2-mAb+Her2-mAb+Endo（HR=0.38；95%CI：0.16-0.88）和 Her2-mAb+Her2-tki+Endo（HR=0.45；95%CI：0.23-0.89），与单纯内分泌治疗相比，显著改善了 PFS。根据累积排序曲线下面积（SUCRA），Her2-mAb+Her2-mAb+Endo 和 Her2-mAb+Her2-tki+Endo 在 PFS 和 OS 方面排名最高。对于不适合内分泌治疗的患者，抗 HER2 双重靶向联合化疗，如 Her2-mAb+Her2-mAb+Chem（HR=0.76；95%CI：0.6-0.96）和 Her2-mAb+Her2-tki+Chem（HR=0.48；95%CI：0.29-0.81），与 Her2-mAb+Chem 相比，PFS 显著改善。与 Her2-tki+Chem 相比也是如此。根据 SUCRA，Her2-mAb+Her2-tki+Chem 和 Her2-mAb+Her2-mAb+Chem 在 PFS 和 OS 方面排名最高。亚组分析一致支持这些总体结果，表明无论治疗线如何，双重靶向治疗都是最佳选择。
