PMID- 32908791 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230718 IS - 1738-6756 (Print) IS - 2092-9900 (Electronic) IS - 1738-6756 (Linking) VI - 23 IP - 4 DP - 2020 Aug TI - Updated Bayesian Network Meta-Analysis of Adjuvant Targeted Treatment Regimens for Early Human Epidermal Growth Factor Receptor-2 Positive Breast Cancer. PG - 410-429 LID - 10.4048/jbc.2020.23.e45 [doi] AB - PURPOSE: Combining targeted agents with adjuvant chemotherapy prolongs survival in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients, but also increases the risk of adverse effects. The updated results of 3 randomized controlled trials (RCTs) were reported in 2019. Given the lack of adequate head-to-head pairwise assessment for anti-HER2 agents, network meta-analysis facilitates obtaining more precise inference for evidence-based therapy. METHODS: RCTs comparing at least 2 anti-HER2 regimens in an adjuvant setting for HER2-positive early-stage breast cancer (EBC) were included. Hazard ratios for overall survival (OS) and disease free survival (DFS), with respective 95% confidence intervals were pooled for assessment of efficacy. A Bayesian statistical model was used, and odds ratios (ORs) for adverse events (AEs) were used to pool effect sizes. RESULTS: We demonstrated that 1-year trastuzumab plus chemotherapy had increased efficacy compared to shorter or longer treatment duration. The OR of cardiac events gradually increased from 6 months to 1 and 2-year trastuzumab arms, relative to chemotherapy only. Compared to trastuzumab plus chemotherapy, dual HER2-targeting therapies increased DFS, especially for hormone receptor negative patients. Dual anti-HER2 blockade regimens revealed an increased probability of gastrointestinal reactions. As a second agent, pertuzumab showed significantly higher DFS and OS. CONCLUSION: We conclude that 1-year adjuvant trastuzumab should remain as the standard treatment for HER2-positive EBC patients, as it has greater efficacy and a manageable proportion of AEs. Clinical efficacy can be increased for hormone receptor-negative tumors by including a second HER2-targeted agent to the treatment regimen. For hormone receptor-positive cases with basal disease, it is acceptable to reduce the risk of cardiotoxicity by shortening the duration of trastuzumab. CI - (c) 2020 Korean Breast Cancer Society. FAU - Li, Xinyan AU - Li X AUID- ORCID: 0000-0003-0710-0293 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. AD - Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Yao, Litong AU - Yao L AUID- ORCID: 0000-0001-9233-5331 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Wang, Mozhi AU - Wang M AUID- ORCID: 0000-0002-0297-2052 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. AD - Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Wang, Mengshen AU - Wang M AUID- ORCID: 0000-0002-3190-6062 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. AD - Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Li, Xiang AU - Li X AUID- ORCID: 0000-0003-2997-6202 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Yu, Xueting AU - Yu X AUID- ORCID: 0000-0002-1463-7630 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Guo, Jingyi AU - Guo J AUID- ORCID: 0000-0001-8857-2254 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Dong, Haoran AU - Dong H AUID- ORCID: 0000-0003-2009-596X AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. AD - Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Sun, Xiangyu AU - Sun X AUID- ORCID: 0000-0003-0023-6841 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. AD - Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China. FAU - Xu, Yingying AU - Xu Y AUID- ORCID: 0000-0003-4924-9379 AD - Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. LA - eng PT - Journal Article PL - Korea (South) TA - J Breast Cancer JT - Journal of breast cancer JID - 101314183 PMC - PMC7462812 OTO - NOTNLM OT - Breast neoplasms OT - Drug therapy OT - ERBB2 protein, human OT - Network meta-analysis OT - Trastuzumab COIS- Conflict of Interest: The authors declare that they have no competing interests. EDAT- 2020/09/11 06:00 MHDA- 2020/09/11 06:01 PMCR- 2020/08/01 CRDT- 2020/09/10 05:36 PHST- 2020/05/01 00:00 [received] PHST- 2020/07/28 00:00 [accepted] PHST- 2020/09/10 05:36 [entrez] PHST- 2020/09/11 06:00 [pubmed] PHST- 2020/09/11 06:01 [medline] PHST- 2020/08/01 00:00 [pmc-release] AID - 10.4048/jbc.2020.23.e45 [doi] PST - ppublish SO - J Breast Cancer. 2020 Aug;23(4):410-429. doi: 10.4048/jbc.2020.23.e45.