Comparative effectiveness of neoadjuvant therapy for HER2-positive breast cancer: a network meta-analysis.

Aiko Nagayama, Tetsu Hayashida, Hiromitsu Jinno, Maiko Takahashi, Tomoko Seki, Akiko Matsumoto, Takeshi Murata, Hutan Ashrafian, Thanos Athanasiou, Koji Okabayashi, Yuukou Kitagawa

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Abstract

The growing number of antihuman epidermal growth factor receptor-2 (HER2) agents suggests the need for defining the optimal choice of neoadjuvant therapy for HER2-positive breast cancer. This study aims to assess the efficacy and safety of neoadjuvant therapy for HER2-positive breast cancer. Randomized trials that compared different anti-HER2 regimens in the neoadjuvant setting were included. The odds ratio (OR) for pathological complete response (pCR), treatment completion, and safety was utilized for pooling effect sizes. Network meta-analysis using a Bayesian statistical model was performed to combine the direct and indirect evidence of neoadjuvant therapy for HER2-positive breast cancer. All statistical tests were two-sided. A database search identified 1047 articles, with 10 studies meeting the eligibility criteria. A total of 2247 patients in seven different treatment arms were assessed. Anti-HER2 agents evaluated included trastuzumab (tzmb), lapatinib (lpnb), and pertuzumab (pzmb). Network meta-analysis showed no statistically significant difference between dual targeting treatment arms; however, lpnb reduced treatment completion due to adverse events. Patients in dual targeting arms had statistically significantly more pCR than those in other treatment arms (chemotherapy [CT] + tzmb + pzmb vs CT + tzmb, OR = 2.29, 95% credibility interval = 1.02 to 5.02, P = .02). The surface under the cumulative ranking probability curve indicated that CT + tzmb + pzmb had the highest probability of being the best treatment arm in terms of pCR. This study indicates that combining two anti-HER2 agents with CT is the most effective treatment modality in the neoadjuvant setting for HER2-positive breast cancer.

Original languageEnglish
JournalJournal of the National Cancer Institute
Volume106
Issue number9
DOIs
Publication statusPublished - 2014

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Neoadjuvant Therapy
Breast Neoplasms
Drug Therapy
Therapeutics
Odds Ratio
Safety
Statistical Models
Network Meta-Analysis
Epidermal Growth Factor Receptor
Databases
Trastuzumab
pertuzumab

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Comparative effectiveness of neoadjuvant therapy for HER2-positive breast cancer : a network meta-analysis. / Nagayama, Aiko; Hayashida, Tetsu; Jinno, Hiromitsu; Takahashi, Maiko; Seki, Tomoko; Matsumoto, Akiko; Murata, Takeshi; Ashrafian, Hutan; Athanasiou, Thanos; Okabayashi, Koji; Kitagawa, Yuukou.

In: Journal of the National Cancer Institute, Vol. 106, No. 9, 2014.

Research output: Contribution to journalArticle

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