Efficacy and safety of first-line regimens for advanced HER2-positive breast cancer: A Bayesian network meta-analysis

Cancer Innovation Pub Date : 2024-05-22 DOI:10.1002/cai2.126

Lixi Li, Yun Wu, Bo Lan, Fei Ma

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Abstract

Background

The current standard of care for advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer is pertuzumab plus trastuzumab and docetaxel as first-line therapy. However, with the development of newer treatment regimens, there is a lack of evidence regarding which is the optimal treatment strategy. The aim of this network meta-analysis was to evaluate the efficacy and safety of first-line regimens for advanced HER2-positive breast cancer by indirect comparisons.

Methods

A systematic review and Bayesian network meta-analysis were conducted. The PubMed, EMBASE, and Cochrane Library databases were searched for relevant articles published through to December 2023. The hazard ratio (HR) and 95% credible interval (CrI) were used to compare progression-free survival (PFS) between treatments, and the odds ratio and 95% CrI were used to compare the objective response rate (ORR) and safety.

Results

Twenty randomized clinical trials that included 15 regimens and 7094 patients were analyzed. Compared with the traditional trastuzumab and docetaxel regimen, PFS was longer on the pyrotinib and trastuzumab plus docetaxel regimen (HR: 0.41, 95% CrI: 0.22–0.75) and the pertuzumab and trastuzumab plus docetaxel regimen (HR: 0.65, 95% CrI: 0.43–0.98). Consistent with the results for PFS, the ORR was better on the pyrotinib and trastuzumab plus docetaxel regimen and the pertuzumab and trastuzumab plus docetaxel regimen than on the traditional trastuzumab and docetaxel regimen. The surface under the cumulative ranking curve indicated that the pyrotinib and trastuzumab plus docetaxel regimen was most likely to rank first in achieving the best PFS and ORR. Comparable results were found for grade ≥3 AE rates of ≥10%.

Conclusions

Our results suggest that the pyrotinib and trastuzumab plus docetaxel regimen is most likely to be the optimal first-line therapy for patients with HER2-positive breast cancer.

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晚期 HER2 阳性乳腺癌一线治疗方案的疗效和安全性：贝叶斯网络荟萃分析

背景晚期人表皮生长因子受体 2 (HER2) 阳性乳腺癌目前的一线治疗标准是百妥珠单抗加曲妥珠单抗和多西他赛。然而，随着新治疗方案的不断开发，关于哪种治疗方法是最佳治疗策略的证据仍然缺乏。本网络荟萃分析旨在通过间接比较评估晚期HER2阳性乳腺癌一线治疗方案的有效性和安全性。方法进行了系统综述和贝叶斯网络荟萃分析。在 PubMed、EMBASE 和 Cochrane Library 数据库中检索了截至 2023 年 12 月发表的相关文章。采用危险比（HR）和 95% 可信区间（CrI）来比较不同疗法的无进展生存期（PFS），采用几率比和 95% 可信区间（CrI）来比较客观反应率（ORR）和安全性。结果分析了20项随机临床试验，包括15种方案和7094名患者。与传统的曲妥珠单抗和多西他赛方案相比，吡罗替尼和曲妥珠单抗加多西他赛方案（HR：0.41，95% CrI：0.22-0.75）以及百妥珠单抗和曲妥珠单抗加多西他赛方案（HR：0.65，95% CrI：0.43-0.98）的PFS更长。与PFS结果一致，吡罗替尼和曲妥珠单抗加多西他赛方案以及pertuzumab和曲妥珠单抗加多西他赛方案的ORR优于传统的曲妥珠单抗和多西他赛方案。累积排名曲线下表面显示，在获得最佳PFS和ORR方面，吡罗替尼和曲妥珠单抗加多西他赛方案最有可能排名第一。≥10%的≥3级AE发生率也有类似结果。结论我们的研究结果表明，对于HER2阳性乳腺癌患者，吡罗替尼和曲妥珠单抗加多西他赛方案最有可能成为最佳一线疗法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Cancer Innovation

CiteScore

0.70

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0.00%

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