Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis
BackgroundThe presence of anti-HER2 agents, such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1), significantly improved the prognosis of metastatic HER2-positive (HER2+) breast cancers (BC). However, drug resistance and disease progression are still common. In order to further improve...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-08-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.731210/full |
| _version_ | 1818729508525572096 |
|---|---|
| author | Xiaohui Zhang Junsheng Leng Yidong Zhou Feng Mao Yan Lin Songjie Shen Qiang Sun |
| author_facet | Xiaohui Zhang Junsheng Leng Yidong Zhou Feng Mao Yan Lin Songjie Shen Qiang Sun |
| author_sort | Xiaohui Zhang |
| collection | DOAJ |
| description | BackgroundThe presence of anti-HER2 agents, such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1), significantly improved the prognosis of metastatic HER2-positive (HER2+) breast cancers (BC). However, drug resistance and disease progression are still common. In order to further improve the treatment efficacy, new clinical trials about anti-HER2 agents in combination with chemotherapy are growing rapidly. We conducted the network meta-analysis to synthesize evidences of clinical trials to identify the best therapy for metastatic HER2+ BC.MethodsA systematic search of randomized controlled trials regarding anti-HER2 agents in combination with chemotherapy for advanced or metastatic breast cancers up to May 2020 was conducted in Embase, PubMed, and the Cochrane Library. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), objective response rate (ORR), and safety. Bayesian network meta-analysis was conducted to synthesize the results and rank the therapies.ResultsTwenty-six studies, including 16 studies for first-line treatments and 10 studies for second- or later-line treatments were included in the network meta-analysis. For first-line studies, the THP (taxanes + trastuzumab + pertuzumab) regimen exhibited the highest probability to be the optimal treatment in all efficacy outcomes and moderate safety. For second- or later-line studies, the T-DM1 and XHTuC (capecitabine + trastuzumab + tucatinib) regimens ranked top two in all efficacy outcomes according to the surface under the cumulative ranking (SUCRA) results. T-DM1 ranked first in PFS and OS whereas XHTuC ranked first in ORR. The safety outcomes of T-DM1 and XHTuC were acceptable.ConclusionsTHP was still the optimal first-line treatment for metastatic HER2+ BC. T-DM1 and XHTuC were recommended for second-line treatments.Systematic Review RegistrationINPLASY.com, identifier (INPLASY202090086). |
| first_indexed | 2024-12-17T22:47:00Z |
| format | Article |
| id | doaj.art-c7382dae2dac493e85e641fc848a27f1 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-17T22:47:00Z |
| publishDate | 2021-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c7382dae2dac493e85e641fc848a27f12022-12-21T21:29:47ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-08-011110.3389/fonc.2021.731210731210Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-AnalysisXiaohui Zhang0Junsheng Leng1Yidong Zhou2Feng Mao3Yan Lin4Songjie Shen5Qiang Sun6Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaDepartment of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaDepartment of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaDepartment of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaDepartment of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaDepartment of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaDepartment of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS), Beijing, ChinaBackgroundThe presence of anti-HER2 agents, such as trastuzumab, pertuzumab, and trastuzumab emtansine (T-DM1), significantly improved the prognosis of metastatic HER2-positive (HER2+) breast cancers (BC). However, drug resistance and disease progression are still common. In order to further improve the treatment efficacy, new clinical trials about anti-HER2 agents in combination with chemotherapy are growing rapidly. We conducted the network meta-analysis to synthesize evidences of clinical trials to identify the best therapy for metastatic HER2+ BC.MethodsA systematic search of randomized controlled trials regarding anti-HER2 agents in combination with chemotherapy for advanced or metastatic breast cancers up to May 2020 was conducted in Embase, PubMed, and the Cochrane Library. The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), objective response rate (ORR), and safety. Bayesian network meta-analysis was conducted to synthesize the results and rank the therapies.ResultsTwenty-six studies, including 16 studies for first-line treatments and 10 studies for second- or later-line treatments were included in the network meta-analysis. For first-line studies, the THP (taxanes + trastuzumab + pertuzumab) regimen exhibited the highest probability to be the optimal treatment in all efficacy outcomes and moderate safety. For second- or later-line studies, the T-DM1 and XHTuC (capecitabine + trastuzumab + tucatinib) regimens ranked top two in all efficacy outcomes according to the surface under the cumulative ranking (SUCRA) results. T-DM1 ranked first in PFS and OS whereas XHTuC ranked first in ORR. The safety outcomes of T-DM1 and XHTuC were acceptable.ConclusionsTHP was still the optimal first-line treatment for metastatic HER2+ BC. T-DM1 and XHTuC were recommended for second-line treatments.Systematic Review RegistrationINPLASY.com, identifier (INPLASY202090086).https://www.frontiersin.org/articles/10.3389/fonc.2021.731210/fullefficacysafetyanti-HER2 agentsmetastatic HER2-positive breast cancernetwork meta-analysis |
| spellingShingle | Xiaohui Zhang Junsheng Leng Yidong Zhou Feng Mao Yan Lin Songjie Shen Qiang Sun Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis Frontiers in Oncology efficacy safety anti-HER2 agents metastatic HER2-positive breast cancer network meta-analysis |
| title | Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis |
| title_full | Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis |
| title_fullStr | Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis |
| title_full_unstemmed | Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis |
| title_short | Efficacy and Safety of Anti-HER2 Agents in Combination With Chemotherapy for Metastatic HER2-Positive Breast Cancer Patient: A Network Meta-Analysis |
| title_sort | efficacy and safety of anti her2 agents in combination with chemotherapy for metastatic her2 positive breast cancer patient a network meta analysis |
| topic | efficacy safety anti-HER2 agents metastatic HER2-positive breast cancer network meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.731210/full |
| work_keys_str_mv | AT xiaohuizhang efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis AT junshengleng efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis AT yidongzhou efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis AT fengmao efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis AT yanlin efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis AT songjieshen efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis AT qiangsun efficacyandsafetyofantiher2agentsincombinationwithchemotherapyformetastaticher2positivebreastcancerpatientanetworkmetaanalysis |