Effectiveness of Added Targeted Therapies to Neoadjuvant Chemotherapy for Breast Cancer: A Systematic Review and Meta-analysis |
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| Institution: | 1. Division of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar, India;2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India;3. Department of Surgical Oncology, BRAIRCH, All India Institute of Medical Sciences, New Delhi, India;4. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India;2. Department of Radiology, Mayo Clinic, Scottsdale, AZ;1. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;2. Section of Nuclear Medicine, University of Lübeck, Lübeck, Germany;3. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia;4. Department of Radiotherapy, Oncology Institute Ion Ciricuta, Cluj-Napoca, Romania;5. Department of Nuclear Medicine, Hanoi Medical University, Hanoi, Viet Nam;6. Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Viet Nam;7. Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, USA;1. Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India;2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India;3. Department of Biomedical Sciences, Shaheed Rajguru College of Applied Sciences, University of Delhi, New Delhi, India;1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA;2. Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA;1. Division of New Drug Development, European Institute of Oncology, Milan, Italy;2. Brigham and Women''s Hospital and Dana Farber Cancer Institute, Boston, MA, USA;3. General Surgery, Department of Advanced Biomedical Science, University Federico II, Naples, Italy;4. Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy |
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| Abstract: | Over the past several years, targeted therapy has been increasingly used in the management of breast cancer. Reported results for targeted therapies are variable, as some randomized controlled trials (RCTs) reported a strong effect, whereas others reported no or minimal effect on the outcomes. Accordingly, the present study aimed to assess the effect of the addition of targeted therapies to neoadjuvant chemotherapy on tumor response rates, breast conserving surgeries, and survival outcomes. PubMed and the Cochrane register of clinical trials were searched on April 28, 2017 for RCTs comparing addition of targeted therapies to neoadjuvant chemotherapy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the screening of records and data extraction were performed by 2 independent reviewers. Publication bias and risk of bias were assessed by the Egger test and the Cochrane tool for risk of bias assessment, respectively. The fixed effect method or random effect method were used to synthesize the results depending on the heterogeneity assessed by the I2 statistic. A total of 17 RCTs including trastuzumab (n = 5), bevacizumab (n = 7), and other targeted therapies (n = 5) were found eligible. Pathologic complete response was significantly higher with trastuzumab (relative risk RR], 2.20; 95% confidence interval CI], 1.62-2.99) and bevacizumab (RR, 1.23; 95% CI, 1.11-1.37), but not with other targeted therapies. Bevacizumab for human epidermal growth factor receptor 2 (HER2)-negative breast cancer was found to be associated with improved overall (hazard ratio, 0.69; 95% CI, 0.53-0.90) and disease-free survival (hazard ratio, 0.83; 95% CI, 0.67-1.03). The addition of targeted therapies may not significantly increase breast conserving surgery rates (RR, 1.04; 95% CI, 0.97-1.12). The addition of targeted therapies, especially trastuzumab for patients with HER2-positive breast cancer and bevacizumab for patients with HER2-negative breast cancer significantly increased pathologic complete response, overall response, and clinical complete response but not breast conserving surgery rates. |
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| Keywords: | Bevacizumab Breast conserving surgery Pathologic complete response Survival Trastuzumab |
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