Comparative Efficacy and Tolerability of Neoadjuvant Immunotherapy Regimens for Patients with HER2-Positive Breast Cancer: A Network Meta-Analysis
Comparative Efficacy and Tolerability of Neoadjuvant Immunotherapy Regimens for Patients with HER2-Positive Breast Cancer: A Network Meta-Analysis
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HER2 阳性乳腺癌患者新辅助免疫治疗方案的疗效和耐受性比较：网络荟萃分析
DOI：
10.1155/2019/3406972
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Wu，Fenfang
中科院分区：
文献类型：
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作者：
Wu，Di;Chen，Tiejun;Wu，Fenfang
该网络荟萃分析解决了对HER 2阳性乳腺癌循证最佳实践治疗方案的需求。我们基于对现有随机对照试验（RCT）数据的系统检索，比较了目前可用的HER 2阳性新辅助免疫治疗方案的相对疗效和耐受性。基于意向治疗原则，采用随机效应、贝叶斯网络荟萃分析和标准配对荟萃分析分析分析病理学完全缓解（pCR）、总体严重不良事件（SAE）和保乳手术（BCS）率。纳入16项RCT（3868例患者）。分析的治疗方案如下：化疗+曲妥珠单抗+帕妥珠单抗（CTP）、曲妥珠单抗-美坦新偶联物+帕妥珠单抗（MP）、化疗+曲妥珠单抗（CT）、化疗+帕妥珠单抗（CP）、曲妥珠单抗+帕妥珠单抗（TP）、化疗+曲妥珠单抗+拉帕替尼（CTL）、化疗+拉帕替尼（CL）和单独化疗（C）。我们发现，对于实现pCR的机会，CTP排名第一（SUCRA：97%），其次是CTL，MP和CT（SUCRA：80%，75%和55%）。MP是最安全的方案（SUCRA：97%），然后是TP、C和TPC（SUCRA：82%、76%和47%）。CTL的毒性最大（SUCRA：7%）。BCS的新辅助治疗方案之间无显著差异。在任何方案中，激素受体状态均不影响pCR的OR。总之，我们的研究结果支持CTP作为HER 2阳性乳腺癌的最佳新辅助治疗方案，与CT相比具有最佳的pCR和可接受的毒性。MP为体能状态较差的患者提供了一种治疗选择。
This network meta-analysis addresses the need for evidence-based best-practice treatment regimens for HER2-positive breast cancer. We compared the relative efficacy and tolerability of currently available HER2-positive neoadjuvant immunotherapy regimens based on systematic searches of available randomized controlled trials (RCTs) data. Based on intention-to-treat principle, pathological complete response (pCR), overall serious adverse events (SAEs), and breast-conserving surgery (BCS) rate were analyzed using random-effect, Bayesian network meta-analysis, and standard pairwise meta-analysis. 16 RCTs (3868 patients) were included. Analyzed treatment regimens were as follows: chemotherapy+trastuzumab+pertuzumab (CTP), trastuzumab emtansine+pertuzumab (MP), chemotherapy+trastuzumab (CT), chemotherapy+pertuzumab (CP), trastuzumab+pertuzumab (TP), chemotherapy+trastuzumab+lapatinib (CTL), and chemotherapy+lapatinib (CL), and chemotherapy (C) alone. We found that, for the chance of achieving pCR, CTP was ranked first (SUCRA: 97%), followed by CTL, MP, and CT (SUCRA: 80%, 75%, and 55%, resp.). MP provided the safest regimen (SUCRA: 97%), then TP, C, and TPC (SUCRA: 82%, 76%, and 47%, resp.). CTL proved the most toxic therapy (SUCRA: 7%). No significant difference between neoadjuvant regimens was identified for BCS. Hormone receptor status did not impact ORs for pCR in any regimen. In conclusion, our findings support CTP as the optimum neoadjuvant regimen for HER2-positive breast cancer, with the best pCR and acceptable toxicity compared with CT. MP provides a therapeutic option for patients with poor performance status.