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Evaluating the clinical effectiveness and safety of various HER2-targeted regimens after prior taxane/trastuzumab in patients with previously treated, unresectable, or metastatic HER2-positive breast cancer: a systematic review and network meta-analysis
- Source :
- Breast Cancer Research and Treatment
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Purpose In the absence of head-to-head trial data, network meta-analysis (NMA) was used to compare trastuzumab emtansine (T-DM1) with other approved treatments for previously treated patients with unresectable or metastatic HER2-positive breast cancer (BC). Methods Systematic reviews were conducted of published controlled trials of treatments for unresectable or metastatic HER2-positive BC with early relapse (≤ 6 months) following adjuvant therapy or progression after trastuzumab (Tras) + taxane published from January 1998 to January 2018. Random-effects NMA was conducted for overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and safety endpoints. Results The NMA included regimens from seven randomized controlled trials: T-DM1 and combinations of Tras, capecitabine (Cap), lapatinib (Lap), neratinib, or pertuzumab (Per; unapproved). OS results favored T-DM1 over approved comparators: hazard ratio (HR) (95% credible interval [95% CrI]) vs Cap 0.68 (0.39, 1.10), LapCap 0.76 (0.51, 1.07), TrasCap 0.78 (0.44, 1.19). PFS trends favored T-DM1 over all other treatments: HR (95% CrI) vs Cap 0.38 (0.19, 0.74), LapCap 0.65 (0.40, 1.10), TrasCap 0.62 (0.34, 1.18); ORR with T-DM1 was more favorable than with all approved treatments. In surface under cumulative ranking curve (SUCRA) analysis T-DM1 ranked highest for all efficacy outcomes. Discontinuation due to adverse events was less likely with T-DM1 than with all comparators except neratinib. In general, gastrointestinal side effects were less likely and elevated liver transaminases and thrombocytopenia more likely with T-DM1 than with comparators. Conclusions The efficacy and tolerability profiles of T-DM1 are generally favorable compared with other treatments for unresectable or metastatic HER2-positive BC.
- Subjects :
- Bridged-Ring Compounds
Oncology
Cancer Research
medicine.medical_specialty
Receptor, ErbB-2
Network Meta-Analysis
Neratinib
Breast Neoplasms
Review
Lapatinib
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Breast cancer
Trastuzumab
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Adjuvant therapy
Humans
Molecular Targeted Therapy
030212 general & internal medicine
Trastuzumab emtansine
Capecitabine
Pertuzumab
business.industry
medicine.disease
Treatment Outcome
Tolerability
chemistry
030220 oncology & carcinogenesis
Female
Taxoids
Locally advanced
business
medicine.drug
Subjects
Details
- ISSN :
- 15737217 and 01676806
- Volume :
- 180
- Database :
- OpenAIRE
- Journal :
- Breast Cancer Research and Treatment
- Accession number :
- edsair.doi.dedup.....f6d734dba58a426e35a3c9ffacb1dc21