Efficacy of second-line treatments for patients with advanced human epidermal growth factor receptor 2 positive breast cancer after trastuzumab-based treatment: a systematic review and bayesian network analysis.
Efficacy of second-line treatments for patients with advanced human epidermal growth factor receptor 2 positive breast cancer after trastuzumab-based treatment: a systematic review and bayesian network analysis.
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DOI：
10.7150/jca.51845
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发表时间：
2021
影响因子：
3.9
通讯作者：
Cui J
中科院分区：
文献类型：
--
作者：
Chen F;Chen N;Lv Z;Li L;Cui J
目的：在随机对照试验（RCT）中检查了曲妥珠单抗耐药人表皮生长因子受体2（HER2）阳性乳腺癌患者的不同二线治疗。网络荟萃分析有助于评估不同选择的比较生存获益。研究方法：我们使用R-4.0.0软件和固定一致性模型进行了一项baidu网络荟萃分析，以比较不同二线方案的无进展生存期（PFS）和总生存期（OS）获益。结果如下：13项RCT（19篇出版物，4313例患者）仍用于定性综合，12项RCT（17篇出版物，4022例患者）被认为有资格进行网络荟萃分析。对于PFS，由于处理之间的连接不足，我们将网络分析分为两个部分。第一部分涉及9项研究中的8种治疗，我们将其称为PFS（#1）。在以下8种干预措施中：吡咯替尼+卡培他滨、T-DM 1 + atezolizumab、帕妥珠单抗+曲妥珠单抗+卡培他滨、T-DM 1、曲妥珠单抗+卡培他滨、拉帕替尼+卡培他滨、来那替尼和卡培他滨，我们发现前三种干预措施之间的获益一致;此外，吡咯替尼+卡培他滨最有可能与最佳获益相关;卡培他滨单药治疗与最差PFS相关。第二部分包括2项研究中的3种治疗，我们将其称为PFS（#2）：依维莫司+曲妥珠单抗+长春瑞滨的PFS获益优于曲妥珠单抗+长春瑞滨和阿法替尼+长春瑞滨。对于OS，我们分析了7项研究中的7种治疗，观察到T-DM 1 + atezolizumab、帕妥珠单抗+曲妥珠单抗+卡培他滨和T-DM 1具有相似的有效性，第一种治疗产生最长OS的可能性最高;卡培他滨或来那替尼单药产生的OS获益最差。结论：我们的工作全面总结和分析了曲妥珠单抗治疗的HER2阳性晚期乳腺癌二线治疗的现有RCT证据。这些结果为临床医生和肿瘤学家提供了有意义的参考临床用药和开发新的有效的治疗方法。
Purpose: Different second-line treatments of patients with trastuzumab-resistant human epidermal growth factor receptor 2 (HER2) positive breast cancer were examined in randomized controlled trials (RCTs). A network meta-analysis is helpful to evaluate the comparative survival benefits of different options. Methods: We performed a bayesian network meta-analysis using R-4.0.0 software and fixed consistency model to compare the progression free survival (PFS) and overall survival (OS) benefits of different second-line regimens. Results: 13 RCTs (19 publications, 4313 patients) remained for qualitative synthesis and 12 RCTs (17 publications, 4022 patients) were deemed eligible for network meta-analysis. For PFS, we divided network analysis into two parts owing to insufficient connections among treatments. The first part involved 8 treatments in 9 studies and we referred it as PFS (#1). Amid the following 8 interventions: pyrotinib + capecitabine, T-DM1 + atezolizumab, pertuzumab + trastuzumab + capecitabine, T-DM1, trastuzumab + capecitabine, lapatinib + capecitabine, neratinib, and capecitabine, we found consistent benefits between the first three interventions; moreover, pyrotinib + capecitabine was most likely to be associated with the best benefits; capecitabine monotherapy was associated with the worst PFS. The second part included 3 treatments in 2 studies and we referred it as PFS (#2): everolimus + trastuzumab + vinorelbine had better PFS benefits versus trastuzumab + vinorelbine and afatinib + vinorelbine. For OS, we analyzed 7 treatments in 7 studies, and observed T-DM1 + atezolizumab, pertuzumab + trastuzumab + capecitabine, and T-DM1 had similar effectiveness, and the first had the highest probability to yield the longest OS; capecitabine or neratinib alone yielded the worst OS benefits. Conclusions: Our work comprehensively summarized and analyzed current available RCT-based evidence of the second-line treatments for trastuzumab-treated, HER2-positive, advanced breast cancer. These results provide clinicians and oncologists meaningful references for clinical drug administration and the development of novel effective therapies.
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