Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, 530021, China.
BMC Cancer. 2024 Oct 18;24(1):1293. doi: 10.1186/s12885-024-13052-5.
Neoadjuvant targeted therapy has shown that improve pathologic complete response and facilitate breast-conserving surgery, but the difference between single-agent treatment or dual-HER2 blockade to the conversion of breast-conserving surgery has not been well described.
Via the systematic literature search of PubMed, Web of Science and Cochrane Library databases, 5 eligible studies used to perform this meta-analysis, which was carried out using RevMan version 5.4.
A total of 1306 patients from five randomized controlled trials were included in the analysis, revealing a significant increase in the conversion rate to breast-conserving surgery with neoadjuvant targeted therapy (OR 0.30, 95% CI 0.15-0.57; p = 0.0003). The odds ratio (OR) for single-agent treatment compared to dual-HER2 blockade was 1.04 (95% CI 0.73-1.48; p = 0.82). For pathological complete response (pCR), the OR for single-HER2 blockade versus dual-HER2 blockade was 0.43 (95% CI 0.34-0.55; p = 0.01), and for clinical response, it was 0.81 (95% CI 0.59-1.10; p = 0.17). The OR for serious adverse events between single-HER2 and dual-HER2 blockade was 0.72 (95% CI 0.55-0.95; p = 0.02). The risk ratio (RR) for pCR and the shift from mastectomy to BCS was 1.16 (95% CI 0.78-1.72; p = 0.47), while for clinical response and the shift from mastectomy to BCS, it was 2.40 (95% CI 1.44-4.01; p = 0.0008).
Neoadjuvant targeted treatment obviously promote the actual implementation rate of breast-conserving surgery, nevertheless, there was no statistically significant increase in single-agent treatment versus dual-HER2 blockade.
新辅助靶向治疗已显示可提高病理完全缓解率并促进保乳手术，但单药治疗与双 HER2 阻断对保乳手术转化率的差异尚未得到很好的描述。
通过对 PubMed、Web of Science 和 Cochrane Library 数据库的系统文献检索，对 5 项符合条件的研究进行了荟萃分析，该分析使用 RevMan 版本 5.4 进行。
共有 5 项随机对照试验的 1306 名患者纳入了分析，结果显示新辅助靶向治疗显著提高了保乳手术的转化率（OR 0.30，95%CI 0.15-0.57；p=0.0003）。与双 HER2 阻断相比，单药治疗的优势比（OR）为 1.04（95%CI 0.73-1.48；p=0.82）。对于病理完全缓解（pCR），单 HER2 阻断与双 HER2 阻断的 OR 为 0.43（95%CI 0.34-0.55；p=0.01），而对于临床反应，OR 为 0.81（95%CI 0.59-1.10；p=0.17）。单 HER2 与双 HER2 阻断之间严重不良事件的 OR 为 0.72（95%CI 0.55-0.95；p=0.02）。pCR 和从乳房切除术转为保乳术的风险比（RR）为 1.16（95%CI 0.78-1.72；p=0.47），而临床反应和从乳房切除术转为保乳术的 RR 为 2.40（95%CI 1.44-4.01；p=0.0008）。
新辅助靶向治疗明显提高了保乳手术的实际实施率，但单药治疗与双 HER2 阻断相比，并没有统计学上的显著增加。
