The combination of trastuzumab and lapatinib added to neoadjuvant chemotherapy for breast cancer: a meta-analysis of randomized evidence

Abstract

Objective To compare the efficacy and safety of trastuzumab versus the combination of trastuzumab and lapatinib added to neoadjuvant chemotherapy in HER2-positive breast cancer. Methods We searched PubMed, MEDLINE, The Cochrane Library, Web of Science, CNKI, Wanfang datebase and the abstracts of major international conferences in recent 5 years to identify randomized controlled trials which met the inclusion and exclusion criteria. Study selection and analyses were undertaken according to the Cochrane Handbook. Meta-analysis was performed using RevMan 5.0 software. Results Four trials were identified with 779 eligible patients. The results of meta-analyses showed that the rate of pathological complete response was significantly higher in the group receiving rastuzumab and tlapatinib than that in the group with trastuzumab alone (53.3%vs 38.8%, RR=1.39, 95 %CI: 1.20-1.63; P<0.001). No statistical differences were observed in regarding adverse events among patients receiving trastuzumab or the combination of trastuzumab and lapatinib, except the grade Ⅲ-Ⅳ diarrhea (2.2%vs 25.6%, RR=11.54, 95%CI: 5.69-23.41; P<0.001). Conclusion The combination of trastuzumab and lapatinib added to neoadjuvant chemotherapy in HER2-positive breast cancer is more effective, without more adverse reactions except diarrhea; it ia an effective and safe treatment. Key words: Breast neoplasms; Neoadjuvant therapy; Meta-analysis; Trastuzumab; Lapatinib