Background

We previously described a systematic assessment of the neoadjuvant therapies for human epidermal growth factor receptor-2 (HER2) positive breast cancer, using network meta-analysis. Accumulation of new clinical data has compelled us to update the analysis.

Methods

Randomized trials comparing different anti-HER2 regimens in the neoadjuvant setting were included, and odds ratio for pathologic complete response (pCR) in seven treatment arms were assessed by pooling effect sizes. Direct and indirect comparisons using a Bayesian statistical model were performed. All statistical tests were two-sided.

Results

A database search identified 993 articles with 13 studies meeting the eligibility criteria, including three new studies with lapatinib (lpnb). In an indirect comparison, dual anti-HER2 agents with CT achieved a better pCR rate than other arms. The credibility intervals of CT + tzmb + lpnb arm were largely reduced compared to our former report, which we added sufficient clinical evidence by this update. Values of surface under the cumulative ranking (SUCRA) suggested that CT + tzmb + pzmb had the highest probability of being the best treatment arm for pCR, widening the difference between the top two dual-HER2 blockade arms compared to our former report. The overall consistency with our first report enhanced the credibility of the results.

Conclusion

Network meta-analysis using new clinical data firmly establish that combining two anti-HER2 agents with CT is most effective against HER2-positive breast cancer in the neoadjuvant setting. New pzmb related trials are required to fully determine the best neoadjuvant dual-HER2 blockade regimen.

中文翻译：

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HER2阳性乳腺癌新辅助疗法的最新网络荟萃分析

背景

我们先前使用网络荟萃分析描述了针对人类表皮生长因子受体2（HER2）阳性乳腺癌的新辅助疗法的系统评估。新的临床数据的积累迫使我们更新分析。

方法

包括在新辅助治疗中比较不同抗HER2方案的随机试验，并通过合并效应量评估了七个治疗组中病理完全缓解（pCR）的优势比。使用贝叶斯统计模型进行直接和间接比较。所有统计检验都是两面的。

结果

数据库搜索确定了993篇文章，其中13篇研究符合资格标准，其中包括3篇关于拉帕替尼（lpnb）的新研究。间接比较中，双重抗HER2药物和CT的pCR率比其他药物更好。与我们以前的报告相比，CT + tzmb + lpnb臂的可信度间隔大大降低了，我们通过此更新添加了足够的临床证据。根据累积排名（SUCRA）得出的地表值表明，CT + tzmb + pzmb是用于pCR的最佳治疗方案的可能性最高，与我们之前的报告相比，前两个双重HER2阻断方案之间的差异更大。与我们的第一份报告的总体一致性提高了结果的可信度。

结论

使用新的临床数据进行的网络荟萃分析牢固地确定，在新辅助治疗中，将两种抗HER2药物与CT结合使用对HER2阳性乳腺癌最有效。需要进行新的pzmb相关试验，以充分确定最佳的新辅助双重HER2阻断方案。