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Meta-Analysis
. 2023 Apr;25(4):941-958.
doi: 10.1007/s12094-022-02998-2. Epub 2022 Nov 22.

Dual neoadjuvant blockade plus chemotherapy versus monotherapy for the treatment of women with non-metastatic HER2-positive breast cancer: a systematic review and meta-analysis

Juan Carlos Vazquez  1   2 , Silvia Antolin  3   4 , Manuel Ruiz-Borrego  4   5 , Sonia Servitja  4   6 , Emilio Alba  4   7   8   9 , Agusti Barnadas  4   9   10   11 , Ana Lluch  4   9   12 , Miguel Martin  4   9   13 , Alvaro Rodriguez-Lescure  4   14 , Ivan Sola  15   16 , Xavier Bonfill  15   11   16 , Gerard Urrutia  15   11   16 , Pedro Sanchez-Rovira  4   17
Affiliations
Meta-Analysis

Dual neoadjuvant blockade plus chemotherapy versus monotherapy for the treatment of women with non-metastatic HER2-positive breast cancer: a systematic review and meta-analysis

Juan Carlos Vazquez et al. Clin Transl Oncol. 2023 Apr.

Abstract

Background: We aimed to determine the effect of dual anti-HER2 blockade compared to monotherapy on clinically important outcomes.

Methods: We carried out a systematic review updated until July 2022. The outcomes included pathological complete response (pCR), clinical response, event-free survival, and overall survival.

Results: We identified eleven randomized clinical trials (2836 patients). When comparing paclitaxel plus dual treatment versus paclitaxel plus trastuzumab or lapatinib, dual treatment was associated with a higher probability of achieving a pathological complete response (OR 2.88, 95% CI 2.02-4.10). Addition of a taxane to an anthracycline plus cyclophosphamide and fluorouracil, plus lapatinib or trastuzumab, showed that the dual treatment was better than lapatinib alone (OR 2.47, 95% CI 1.41-4.34), or trastuzumab alone (OR 1.89, 95% CI 1.13-3.16). Dual treatment may result in an increase in survival outcomes and tumour clinical response, although such benefits are not consistent for all the combinations studied.

Conclusions: The use of dual blockade with combinations of trastuzumab and pertuzumab can be recommended for the neoadjuvant treatment of women with HER2-positive breast cancer. PROSPERO Registration number: CRD42018110273.

Keywords: Breast cancer; Human epidermal growth factor receptor; Lapatinib; Neoadjuvant; Pathological complete response; Trastuzumab.

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