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Meta-Analysis
. 2023 Sep:186:109805.
doi: 10.1016/j.radonc.2023.109805. Epub 2023 Jul 10.

Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy: A systematic review and meta-analysis

Viola Salvestrini  1 , Kyubo Kim  2 , Saverio Caini  3 , Sara Alkner  4 , Maria Ekholm  5 , Tanja Skyttä  6 , Carlotta Becherini  1 , Charlotte E Coles  7 , Orit Kaidar-Person  8 , Birgitte Offersen  9 , Evandro de Azambuja  10 , Luca Visani  1 , Javier Cortes  11 , Nadia Harbeck  12 , Hope S Rugo  13 , Clare M Isacke  14 , Elisabetta Marangoni  15 , Andrea Morandi  16 , Matteo Lambertini  17 , Philip Poortmans  18 , Lorenzo Livi  1 , Icro Meattini  19
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Free article
Meta-Analysis

Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy: A systematic review and meta-analysis

Viola Salvestrini et al. Radiother Oncol. 2023 Sep.
Free article

Abstract

Background and purpose: In recent years, the treatment landscape for breast cancer has undergone significant advancements, with the introduction of several new anticancer agents. One such agent is trastuzumab emtansine (T-DM1), an antibody drug conjugate that has shown improved outcomes in both early and advanced breast cancer. However, there is currently a lack of comprehensive evidence regarding the safety profile of combining T-DM1 with radiation therapy (RT). In this study, we aim to provide a summary of the available data on the safety of combining RT with T-DM1 in both early and metastatic breast cancer settings.

Materials and methods: This systematic review and meta-analysis project is part of the consensus recommendations by the European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee on integrating RT with targeted treatments for breast cancer. A thorough literature search was conducted using the PUBMED/MedLine, Embase, and Cochrane databases to identify original studies focusing on the safety profile of combining T-DM1 with RT.

Results: After applying eligibility criteria, nine articles were included in the meta-analysis. Pooled data from these studies revealed a high incidence of grade 3 + radionecrosis (17%), while the rates of grade 3 + radiation-related pneumonitis (<1%) and skin toxicity (1%) were found to be very low.

Conclusion: Although there is some concern regarding a slight increase in pneumonitis when combining T-DM1 with postoperative RT, the safety profile of this combination was deemed acceptable for locoregional treatment in non-metastatic breast cancer. However, caution is advised when irradiating intracranial sites concurrently with T-DM1. There is a pressing need for international consensus guidelines regarding the safety considerations of combining T-DM1 and RT for breast cancer.

Keywords: Breast cancer; Meta-analysis; Radiotherapy; Systematic review; T-DM1; Trastuzumab emtansine.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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