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One year versus a shorter duration of adjuvant trastuzumab for HER2-positive early breast cancer: a systematic review and meta-analysis

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Abstract

Introduction

One year is the standard duration of adjuvant trastuzumab for human epidermal receptor-2 (HER2) positive (HER2+) breast cancer (BC). Indeed, a shorter duration of trastuzumab can reduce cardiotoxicity and the costs involved and could provide the same benefit as a one-year treatment. We evaluated the available evidence from randomised controlled trials (RCTs) by comparing 1 year versus a shorter duration of adjuvant trastuzumab for HER2+ BC.

Patients and methods

A systematic search of PubMed, EMBASE, The Cochrane Library and conference proceedings was carried out in order to identify the RCTs that investigated a standard versus a shorter duration of adjuvant trastuzumab in HER2+ BC patients. Using the fixed and random effects models, the pooled hazard ratios (HRs) and risk ratio (RR) with 95% confidence intervals (CI) were calculated for overall survival (OS), disease-free survival (DFS) and cardiac events.

Results

Five RCTs with a total of 11,381 patients were included. Overall, one year of adjuvant trastuzumab improved OS (HR 1.22, 95% CI 1.07–1.39; P = 0.003) and DFS (HR 1.19, 95% CI 1.08–1.3; P < 0.001) compared with a shorter duration (6 months and 9 weeks). In the subgroup analysis, there was a trend towards better DFS with the 1-year duration for patients with high-risk features, and also for concomitant administration of chemotherapy and trastuzumab. Cardiac events were significantly lower with a shorter duration (RR 0.4, 95% CI 0.32–0.49; P < 0.001).

Conclusions

One-year adjuvant trastuzumab is associated with better DFS and OS compared with shorter durations and should still be considered the standard duration. However, selected patients with low-risk HER2+ BC can most likely be spared from an excess of cardiac toxicity with a shorter course.

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Authors and Affiliations

  1. Oncology Unit, Cancer Care Center, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy

    Alessandro Inno

  2. Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy

    Sandro Barni & Fausto Petrelli

  3. Oncology Unit, Casa di Cura Igea, Via Marcona 69, 20144, Milan, Italy

    Antonio Ghidini

  4. Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy

    Alberto Zaniboni

Authors
  1. Alessandro Inno
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  2. Sandro Barni
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  3. Antonio Ghidini
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  4. Alberto Zaniboni
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  5. Fausto Petrelli
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Correspondence to Fausto Petrelli.

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Inno, A., Barni, S., Ghidini, A. et al. One year versus a shorter duration of adjuvant trastuzumab for HER2-positive early breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 173, 247–254 (2019). https://doi.org/10.1007/s10549-018-5001-x

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  • DOI: https://doi.org/10.1007/s10549-018-5001-x

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