HER2+ breast cancer: mastectomy tops BCS in the absence of trastuzumab

  • He L & al.
  • Cancer Manag Res
  • 1 Jan 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A meta-analysis finds that in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer:
    • Adjuvant trastuzumab is no better than neoadjuvant trastuzumab.
    • Mastectomy is better than breast-conserving surgery (BCS), but only in those failing to receive trastuzumab.

Why this matters

  • This is among the first meta-analyses of its kind for patients with HER2+ early breast cancer.

Study design

  • Meta-analysis of 12 clinical trials (N=2366) identified from a search of PubMed, Embase, Web of Science, and Cochrane Library.
  • Funding: None disclosed.

Key results

  • No difference in OS between adjuvant trastuzumab and neoadjuvant trastuzumab (OR, 1.04; 95% CI, 0.47-2.33).
  • Mastectomy had lower local-regional recurrence than BCS (OR, 0.58; 95% CI, 0.38-0.89), but subgroup analysis found:
    • Mastectomy was better than BCS only in the absence of trastuzumab (OR, 0.52; 95% CI, 0.31-0.88).
    • Mastectomy and BCS were equally effective in patients who received trastuzumab (OR, 0.71; 95% CI, 0.34-1.49).

Limitations

  • Small number of studies, low sample size.
  • Subgroup analysis was only conducted on the subset of studies (n=5) in which trastuzumab use was documented.

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