Efficacy And Safety Of Double Target Combined Chemotherapy For HER2 Positive Breast Cancer:A Systematic Review And Meta-analysis

Background:To evaluate the efficacy and safety of double target combined chemotherapy compared with single target combined chemotherapy in the treatment of HER2 positive breast cancerMethod:Through searching PubMed database,EMBASE,the Cochrane Library,CNKI and Wanfang database and abstracts of major international conferences,the possible eligible tests were determined.The end points of our study were the rate of pathological complete response(PCR),disease free survival(DFS),progress free survival(PFS),overall survival(OS)and adverse events(AEs)According to the heterogeneity between the studies,the risk ratio(RR)and 95%confidence interval(CI)of each study end point were calculated by using fixed or random effect model.Revman 5.3 and Stata 14.0 were used for meta analysis Result:This study included 13 RCTs,a total of 14774 patients.In terms of efficacy 8 RCTs were included in the new adjuvant therapy.The results showed that the PCR rate in the group receiving double target anti HER2 therapy was higher than that in the group receiving single target anti HER2 therapy(RR,1.47;95%Cl[1.11,1.94],P=0.006).The results of subgroup analysis showed that the PCR rate of trastuzumab+patorzumab(RR,1.74,95%Cl[1.15-2.01],P<0.00001)was higher than that of trastuzumab+lapatinib(RR,1.37,95%CI[0.86-2.18],P<0.00001).In the treatment of advanced breast cancer,in evaluating the OS rate,3 RCTs were included.The results showed that the OS rate in the group receiving double target anti HER2 therapy was higher than that in the group receiving single target anti HER2 therapy(RR,1.55;95%Cl[1.22,1.96],P=0.0003).In evaluating the PFS rate,2 RCTs were included.The results showed that the PFS rate in the group receiving double target anti HER2 therapy was higher than that in the group receiving single target anti HER2 therapy(RR,1.48;95%Cl[1.10,2.00],P=0.009).In adjuvant therapy,in evaluating the OS rate,2 RCTs were included.The results showed that the OS rate in the group receiving double target anti HER2 therapy was higher than that in the group receiving single target anti HER2 therapy(RR,1.33;95%Cl[1.13,1.57],P=0.0008).In evaluating the DFS rate,2 RCTs were included.The results showed that the DFS rate in the group receiving double target anti HER2 therapy was higher than that in the group receiving single target anti HER2 therapy(RR,1.33;95%Cl[1.17,1.50],P<0.00001).With regard to safety,diarrhea was more common in the double target anti HER2 treatment group(RR,1.82;95%Cl[1.42,2.32],P<0.00001),and rash was more common in the double target anti HER2 treatment group(RR,1.38;95%Cl[1.09,1.74],P=0.007).Except diarrhea and rash,there was no significant difference between the two groupsConclusion:1.Compared with single-target combined chemotherapy for HER2-positive breast cancer,double-target combined chemotherapy has a higher PCR rate in neoadjuvant therapy;higher OS rate and DFS rate in adjuvant therapy;OS rate and PFS rate in advanced therapy higher2.Except for diarrhea and rash,there is no difference in other adverse reactions3.In neoadjuvant therapy,trastuzumab+pertuzumab has a higher PCR rate than trastuzumab+lapatinib in the dual-target anti-HER2 positive breast cancer treatment.