Jiang Yi-Cheng, Yang Jing-Jing, Zhang Hai-Tian, Zhuo Rui, De La Roche Sebastian, Torres-De La Roche Luz Angela, De Wilde Rudy Leon, Dong Jie
Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin Traditional Chinese Medicine Hospital of China, Guilin, Guangxi Zhuang Autonomous Region 541002, P.R. China.
Department of Neonates, Guilin People's Hospital, Guilin, Guangxi Zhuang Autonomous Region 541001, P.R. China.
Oncol Lett. 2024 Aug 28;28(5):513. doi: 10.3892/ol.2024.14646. eCollection 2024 Nov.
Endocrine therapy has become the fundamental treatment option for hormone receptor-positive (HR) and receptor tyrosine-protein kinase erbB-2-negative (HER2) metastatic breast cancer (mBC). While treatments incorporating cyclin-dependent kinase (CDK)4 and 6 inhibitors are more prevalent than ever, comparisons among those regimens are scarce. The aim of the present study was to identify the most effective maintenance treatment for patients with HR and HER2 mBC. To this end, databases including PubMed, Embase, Cochrane Library, Scopus and Google Scholar were searched from inception to August, 2023. The endpoints comprised overall survival (OS) and progression free survival (PFS). For dichotomous variants, hazard ratios (HRs) and odds ratios (ORs) were generated, while standard mean difference (SMD) was used for consecutive variants by Bayesian network meta-analysis to make pairwise comparisons among regimens, to determine the optimal therapy. These processes were conducted using Rstudio 4.2.2 orchestrated with STATA 17.0 MP. A total of 16 randomized controlled trials including 7,174 patients with 11 interventions were analyzed. Compared with aromatase inhibitor (AI), palbociclib plus AI (PalboAI) exhibited a significantly longer PFS up to the 36th month of follow-up [HR=1.7; 95% credible interval, 1.36-2.16], including on the 3rd [OR=2.22; 95% confidence interval (CI), 1.10-4.47], 6th (OR=2.39; 95% CI, 1.21-4.69), 12th (OR=1.94; 95% CI, 1.34-2.79), 18th (OR=2.38; 95% CI, 1.65-3.44), 24th (OR=2.39; 95% CI, 1.67-3.43), 30th (OR=2.10; 95% CI, 1.62-2.74) and 36th (OR=2.66; 95% CI, 1.37-5.18) month of follow-up. Additionally, abemaciclib plus fulvestrant exhibited significant effects compared with AI alone between 12 and 36 months. Ribociclib plus fulvestrant, ribociclib plus AI and dalpiciclib plus AI exerted significant effects compared with AI alone between 12 and 30 months. Considering the effect on OS and PFS together with adverse reactions, safety, medical compliance and route of administration, PalboAI was found to be the optimal treatment for HR/HER2mBC. However, additional head-to-head clinical trials are warranted to confirm these findings.
内分泌治疗已成为激素受体阳性（HR）且受体酪氨酸蛋白激酶erbB-2阴性（HER2）的转移性乳腺癌（mBC）的基本治疗选择。虽然包含细胞周期蛋白依赖性激酶（CDK）4和6抑制剂的治疗比以往任何时候都更普遍，但这些方案之间的比较却很少。本研究的目的是确定HR和HER2 mBC患者最有效的维持治疗方案。为此，检索了包括PubMed、Embase、Cochrane图书馆、Scopus和谷歌学术在内的数据库，检索时间从数据库建立至2023年8月。终点指标包括总生存期（OS）和无进展生存期（PFS）。对于二分变量，生成风险比（HRs）和比值比（ORs），而通过贝叶斯网络荟萃分析对连续变量使用标准化均数差（SMD），以便在各方案之间进行成对比较，从而确定最佳治疗方案。这些过程使用Rstudio 4.2.2并结合STATA 17.0 MP进行。共分析了16项随机对照试验，包括7174例患者及11种干预措施。与芳香化酶抑制剂（AI）相比，哌柏西利联合AI（PalboAI）在随访至第36个月时显示出显著更长的PFS [HR=1.7；95%可信区间，1.36 - 2.16]，包括在第3个月[OR=2.22；95%置信区间（CI），1.10 - 4.47]、第6个月（OR=2.39；95% CI，1.21 - 4.69）第12个月（OR=1.94；95% CI，1.34 - 2.79）、第18个月（OR=2.38；95% CI，1.65 - 3.44）、第24个月（OR=2.39；95% CI, 1.67 - 3.43）、第30个月（OR=2.10；95% CI，1.62 - 2.74）和第36个月（OR=2.66；95% CI，1.37 - 5.18）的随访结果。此外，在12至36个月期间，阿贝西利联合氟维司群与单独使用AI相比显示出显著效果。在12至30个月期间，瑞博西利联合氟维司群、瑞博西利联合AI以及达尔西利联合AI与单独使用AI相比均显示出显著效果。综合考虑对OS和PFS的影响以及不良反应、安全性、药物依从性和给药途径，发现PalboAI是HR/HER2 mBC的最佳治疗方案。然而，需要进行更多的直接比较临床试验来证实这些发现。
