Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2024 Feb 28;15:1254213. doi: 10.3389/fendo.2024.1254213. eCollection 2024.
The role of simultaneous neoadjuvant endocrine therapy in chemotherapy in HR+HER2- breast cancer continues to be controversial. This systematic review and meta-analysis was conducted to further evaluate the effectiveness and safety of this strategy for HR+HER2- breast cancer patients. Trials in which HR+HER2- breast cancer patients were randomly assigned to either single or simultaneous endocrine-assisted neoadjuvant chemotherapy were eligible for inclusion. The prime endpoint was the pathological complete response (pCR) rate. The clinical response (complete clinical response: CR, partial response: PR) and safety were secondary endpoints. A random effect model was used for statistical analysis. A total of 690 patients from five trials were included. PCR rate was 10.43% in the concomitant endocrine group and 7.83% in control group (OR=1.37, 95%CI 0.72-2.60, P=0.34). The CR rate was 15.50% for the concomitant endocrine group and 10.26% for the control group. (OR=1.61, 95%CI 0.99-2.61, P=0.05). ORR (CR+PR) was significantly higher in the simultaneous endocrine group compared to the control group (79.53% (272/342) vs. 70.09% (239/341) , OR=1.70, 95%CI 1.19-2.43, P=0.004) and the meta-analysis approach showed no heterogeneity (I 0%, P=0.54) . Tamoxifen concurrent with chemotherapy could increase the frequency of adverse events, whereas aromatase inhibitors (AIs) would not. Our findings provide evidence for the efficacy and safety of concurrent neoadjuvant endocrine therapy (AIs) with chemotherapy as an available option to achieve a higher clinical response rate for HR+HER2- breast cancer patients compared with chemotherapy alone with low toxicity.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022340725.
HR+HER2-乳腺癌患者新辅助内分泌治疗与化疗同时进行的作用仍存在争议。本系统评价和荟萃分析旨在进一步评估该策略对 HR+HER2-乳腺癌患者的有效性和安全性。符合纳入标准的试验为将 HR+HER2-乳腺癌患者随机分为单药或同时内分泌辅助新辅助化疗的试验。主要终点为病理完全缓解（pCR）率。临床反应（完全临床反应：CR，部分反应：PR）和安全性为次要终点。采用随机效应模型进行统计学分析。共纳入来自五项试验的 690 例患者。联合内分泌组的 pCR 率为 10.43%，对照组为 7.83%（OR=1.37，95%CI 0.72-2.60，P=0.34）。联合内分泌组的 CR 率为 15.50%，对照组为 10.26%（OR=1.61，95%CI 0.99-2.61，P=0.05）。联合内分泌组的客观缓解率（CR+PR）明显高于对照组（79.53%（272/342）vs. 70.09%（239/341），OR=1.70，95%CI 1.19-2.43，P=0.004），且荟萃分析方法无异质性（I 0%，P=0.54）。与化疗相比，他莫昔芬联合化疗可增加不良事件的发生频率，而芳香化酶抑制剂（AIs）则不会。我们的研究结果为 HR+HER2-乳腺癌患者新辅助内分泌治疗（AIs）与化疗同时进行的有效性和安全性提供了证据，与单独化疗相比，这种方法毒性较低，但可提高临床缓解率。
https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD42022340725。
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