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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

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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.

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Data availability

All data generated or analysed during this study are included in this published article (and its supplementary information files).

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Funding

The authors received funding from GEICAM Spanish Breast Cancer Group. This work was developed within a project aimed to update the GEICAM previous clinical guidelines.

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Authors and Affiliations

  1. Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain

    Juan Carlos Vazquez, Ivan Sola, Xavier Bonfill & Gerard Urrutia

  2. Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18, planta 0, 08025, Barcelona, Spain

    Juan Carlos Vazquez

  3. Medical Oncology Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain

    Silvia Antolin

  4. GEICAM Spanish Breast Cancer Group, Madrid, Spain

    Silvia Antolin, Manuel Ruiz-Borrego, Sonia Servitja, Emilio Alba, Agusti Barnadas, Ana Lluch, Miguel Martin, Alvaro Rodriguez-Lescure & Pedro Sanchez-Rovira

  5. Medical Oncology Unit, Hospital Universitario Virgen del Rocío de Sevilla, Seville, Spain

    Manuel Ruiz-Borrego

  6. Medical Oncology Unit, Hospital del Mar de Barcelona, Barcelona, Spain

    Sonia Servitja

  7. UGCI Oncología Médica, Hospitales Regional y Virgen de la Victoria, Málaga, Spain

    Emilio Alba

  8. IBIMA, Málaga, Spain

    Emilio Alba

  9. Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain

    Emilio Alba, Agusti Barnadas, Ana Lluch & Miguel Martin

  10. Medical Oncology Service, Hospital de la Santa Creu I Sant Pau de Barcelona, Barcelona, Spain

    Agusti Barnadas

  11. Universitat Autònoma de Barcelona, Barcelona, Spain

    Agusti Barnadas, Xavier Bonfill & Gerard Urrutia

  12. Medical Oncology Unit, Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Universidad de Valencia, Valencia, Spain

    Ana Lluch

  13. Medical Oncology Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain

    Miguel Martin

  14. Medical Oncology Unit, Hospital General Universitario de Elche, Elche, Spain

    Alvaro Rodriguez-Lescure

  15. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Ivan Sola, Xavier Bonfill & Gerard Urrutia

  16. Medical Oncology Unit, Hospital Universitario de Jaen, Jaen, Spain

    Pedro Sanchez-Rovira

Authors
  1. Juan Carlos Vazquez
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  2. Silvia Antolin
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Correspondence to Juan Carlos Vazquez.

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Juan Carlos Vazquez is PhD candidate Program in Biomedical Research Methodology and Public Health, Universitat Autònoma de Barcelona.

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Vazquez, J.C., Antolin, S., Ruiz-Borrego, M. et al. 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. Clin Transl Oncol 25, 941–958 (2023). https://doi.org/10.1007/s12094-022-02998-2

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