Abstract
ABSTRACTObjective: Breast cancer remains to be the globally leading female cancer. About 15% to 20% of breast cancers have human epidermal growth factor receptor 2 (HER2)-positive tumors – a more aggressive breast cancer subtype with shortened survival. In the light of new and updated trial data on trastuzumab therapy for HER2-positive early-stage breast cancer (EBC), we conducted a systematic review and meta-analysis to update the pooling of its relative treatment effects.Methods: Systematic search was performed through Pubmed and Scopus to identify studies comparing survival outcomes and risks of heart toxicity effects of adjuvant trastuzumab with chemotherapy versus chemotherapy alone for HER2-positive EBC patients.Results: Based on the eight included studies in the review, combining trastuzumab with chemotherapy continues to show lowered death and relapse risks by one-third. The decision to initiate trastuzumab, however, needs to be prudently deliberated as two to three times more cardiotoxicity risk was shown to be associated with its use.Conclusion: Administering adjuvant trastuzumab in a weekly cycle concurrently with anthracycline-taxane chemotherapy regimen appears to be a preferable option to optimize its favorable effect in improving DFS and to prevent significantly higher risk for cardiotoxic effects.
Highlights
Breast cancer remains to be the leading cancer among women across the world with approximately 1.67 million cases and 521,907 deaths in 2012 as for the GLOBOCAN cancer incidence, mortality and prevalence report [1]
Electronic searching for relevant studies published from inception to 8 July 2017 was performed through two electronic databases (i.e. Medline via PubMed and Scopus), without language restrictions using search terms and strategies described in Table S1 (Supporting Information)
We conducted a systematic review and meta-analysis of eight RCTs which demonstrated that adding adjuvant trastuzumab to chemotherapy compared to chemotherapy alone in HER2positive early-stage breast cancer (EBC) patients can reduce the risk of mortality and recurrence of 33% and 35%, respectively
Summary
Breast cancer remains to be the leading cancer among women across the world with approximately 1.67 million cases and 521,907 deaths in 2012 as for the GLOBOCAN cancer incidence, mortality and prevalence report [1]. The World Health Organization reported that in 2008, almost 50% (691,300/ 1,383,500) of breast cancer cases and 58% (268,900/458,400) of breast cancer deaths occurred in less developed countries, contrary to the notion that breast cancer was a disease of developed countries [2]. They further reported that survival rates for breast cancer varied greatly worldwide, i.e., 80%, 60%, and 40% survival rates in high-income, middle-income and in low-income countries, respectively [3]. The prevalence of HER2-positive breast cancer in Western population was approximately 15% to 20% of primary breast cancers [6], which was not much different compared to the estimated HER2 positivity rate in Asian population which was about 23.5% [7]
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