TY - JOUR
T1 - Neoadjuvant dual HER2-targeted therapy with lapatinib and trastuzumab improves pathologic completeresponse in patients with early stage HER2-positive breast cancer
T2 - A meta-analysis of randomized prospective clinical trials
AU - Hicks, Mellissa
AU - Macrae, Erin R.
AU - Abdel-Rasoul, Mahmoud
AU - Layman, Rachel
AU - Friedman, Susan
AU - Querry, Jenny
AU - Lustberg, Maryam
AU - Ramaswamy, Bhuvaneswari
AU - Mrozek, Ewa
AU - Shapiro, Charles
AU - Wesolowski, Robert
N1 - Publisher Copyright:
© AlphaMed Press 2015.
PY - 2015/3/2
Y1 - 2015/3/2
N2 - Background. Randomized clinical trials (RCT) that evaluated the addition of lapatinib to trastuzumab plus neoadjuvant chemotherapy (NAC) in patients with HER2-positive, operable breast cancer revealed a questionable improvement in pathologic complete response (pCR) rate. We performed a metaanalysis of prospective RCTs that examined the effect of adding lapatinib to trastuzumab and NAC on pCR rate. Methods. PubMed databases and abstracts from the proceedings of the American Society of Clinical Oncology and the San Antonio Breast CancerSymposiumweresearched forRCTs that compared lapatinib plus trastuzumab and NAC with trastuzumab in combination with NAC and that included pCR as the primary outcome. Our main objective was to estimate the effect of adding lapatinib to trastuzumab plusNACon pCR rate, defined as no residual invasive cancer in breast and axillary lymph nodes. Results. In total, 1,017 patients with early stage breast cancer from 5 trials were included. Four trials examined the addition of lapatinib to trastuzumab plus NAC; this resulted in statistically significant improvement in pCR, defined as no residual carcinoma in breast and lymph nodes.The pCR rate was 55.76% and 38.36% in the lapatinib plus trastuzumab and the trastuzumab plus NAC arms, respectively (odds ratio [OR]: 1.94; 95% confidence interval [CI]: 1.44–2.60). In three trials, the rates of pCR, defined as no residual invasive carcinoma in breast only, for the lapatinib plus trastuzumab and trastuzumabalone groupswere 55.01%and40.70%, respectively, also resulting in significant improvement (OR: 1.78; 95% CI: 1.27–2.50). Conclusion. The addition of lapatinib to trastuzumab in combination with neoadjuvant chemotherapy significantly improves pCR rates in patients with HER2-positive breast cancer.
AB - Background. Randomized clinical trials (RCT) that evaluated the addition of lapatinib to trastuzumab plus neoadjuvant chemotherapy (NAC) in patients with HER2-positive, operable breast cancer revealed a questionable improvement in pathologic complete response (pCR) rate. We performed a metaanalysis of prospective RCTs that examined the effect of adding lapatinib to trastuzumab and NAC on pCR rate. Methods. PubMed databases and abstracts from the proceedings of the American Society of Clinical Oncology and the San Antonio Breast CancerSymposiumweresearched forRCTs that compared lapatinib plus trastuzumab and NAC with trastuzumab in combination with NAC and that included pCR as the primary outcome. Our main objective was to estimate the effect of adding lapatinib to trastuzumab plusNACon pCR rate, defined as no residual invasive cancer in breast and axillary lymph nodes. Results. In total, 1,017 patients with early stage breast cancer from 5 trials were included. Four trials examined the addition of lapatinib to trastuzumab plus NAC; this resulted in statistically significant improvement in pCR, defined as no residual carcinoma in breast and lymph nodes.The pCR rate was 55.76% and 38.36% in the lapatinib plus trastuzumab and the trastuzumab plus NAC arms, respectively (odds ratio [OR]: 1.94; 95% confidence interval [CI]: 1.44–2.60). In three trials, the rates of pCR, defined as no residual invasive carcinoma in breast only, for the lapatinib plus trastuzumab and trastuzumabalone groupswere 55.01%and40.70%, respectively, also resulting in significant improvement (OR: 1.78; 95% CI: 1.27–2.50). Conclusion. The addition of lapatinib to trastuzumab in combination with neoadjuvant chemotherapy significantly improves pCR rates in patients with HER2-positive breast cancer.
KW - Breast cancer
KW - HER2
KW - Lapatinib
KW - Meta-analysis
KW - Neoadjuvant chemotherapy
KW - Trastuzumab
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UR - http://www.scopus.com/inward/citedby.url?scp=84927595565&partnerID=8YFLogxK
U2 - 10.1634/theoncologist.2014-0334
DO - 10.1634/theoncologist.2014-0334
M3 - Article
C2 - 25732265
AN - SCOPUS:84927595565
SN - 1083-7159
VL - 20
SP - 337
EP - 343
JO - Oncologist
JF - Oncologist
IS - 4
ER -