Efficacy of lapatinib versus trastuzumab in neoadjuvant therapy of HER-2 positive breast cancer: a meta-analysis

Abstract

To compare the efficacy of lapatinib or lapatinib plus trastuzumab versus trastuzumab in the neoadjuvant therapy of human epidermal growth factor receptor 2 (HER-2) positive breast cancer. MEDLINE database, American Society of Clinical Oncology (ASCO), San Antonio Breast Cancer Symposium (SABCS), European Society for Medical Oncology (ESMO) proceedings and China Biomedical Database were searched for literatures of trastuzumab or lapatinib in neoadjuvant therapy for breast cancer. There was no limit of language or time. A meta-analysis was performed for retrieved literatures meeting the inclusion criteria. A total of 1 794 breast cancer patients from 5 clinical trials were included. And the regimens were lapatinib plus neoadjuvant chemotherapy (n = 719), trastuzumab plus neoadjuvant chemotherapy (n = 714) and both drugs plus neoadjuvant chemotherapy (n = 361). The rate of pathological complete remission (pCR) was lower in lapatinib group than that in trastuzumab group (28.2% vs 35.4%). And the difference was statistically significant (P = 0.004). The pCR rate was significantly higher in lapatinib plus trastuzumab therapy group than that in trastuzumab group (53.2% vs 38.1%, P < 0.001). Lapatinib can not replace trastuzumab as a first-choice agent in neoadjuvant therapy of HER-2 positive breast cancer. Lapatinib plus trastuzumab achieves better pCR than trastuzumab so that it and may become a first-choice of neoadjuvant therapy for HER-2 positive breast cancer regardless of economic affordability for patients.