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Efficacy and safety of first-line regimens for advanced HER2-positive breast cancer: A Bayesian network meta-analysis
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
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.
Insights
Pyrotinib plus trastuzumab and docetaxel shows superior efficacy for advanced HER2-positive breast cancer. This regimen is likely the optimal first-line therapy, improving progression-free survival and objective response rates.
Area of Science:
- Oncology
- Clinical Pharmacology
- Biostatistics
Background:
- Advanced HER2-positive breast cancer treatment relies on pertuzumab, trastuzumab, and docetaxel.
- Emerging therapies necessitate an evaluation of optimal first-line treatment strategies.
- Evidence comparing newer regimens for advanced HER2-positive breast cancer is limited.
Purpose of the Study:
- To conduct a network meta-analysis comparing first-line treatment regimens for advanced HER2-positive breast cancer.
- To evaluate the efficacy (progression-free survival, objective response rate) and safety of various regimens.
- To identify the optimal first-line therapy through indirect treatment comparisons.
Main Methods:
- Systematic review and Bayesian network meta-analysis.
- Searched PubMed, EMBASE, and Cochrane Library databases up to December 2023.
- Analyzed 20 randomized clinical trials involving 7094 patients and 15 regimens.
Main Results:
- Pyrotinib plus trastuzumab and docetaxel significantly improved progression-free survival (PFS) (HR: 0.41) and objective response rate (ORR) compared to traditional trastuzumab and docetaxel.
- Pertuzumab plus trastuzumab and docetaxel also showed improved PFS (HR: 0.65) and ORR.
- Pyrotinib-based regimen ranked highest for PFS and ORR; similar rates for grade ≥3 adverse events.
Conclusions:
- Pyrotinib plus trastuzumab and docetaxel is likely the optimal first-line therapy for advanced HER2-positive breast cancer.
- This regimen offers superior efficacy in terms of PFS and ORR.
- The findings provide valuable evidence for clinical decision-making in this patient population.
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