Adjuvant treatment with trastuzumab of patients with HER2-positive, T1a-bN0M0 breast tumors: A systematic review and meta-analysis. (April 2023)

• Record Type: Journal Article
• Authors: Hassing, Christina M.S.; Nielsen, Dorte Lisbet; Knoop, Ann Søegaard; Tvedskov, Tove Holst Filtenborg; Kroman, Niels; Lænkholm, Anne-Vibeke; Juhl, Carsten Bogh; Kümler, Iben
• Is Part Of: Critical reviews in oncology/hematology. Volume 184(2023)
• Publication Date: 2023-04
• Subjects: Breast cancer -- T1abN0 -- Human epidermal growth factor receptor 2 (HER2) -- Trastuzumab -- Meta-analysis; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2023.103952
• Languages: English
• ISSNs: 1040-8428

Abstract

Abstract: The benefit of adjuvant trastuzumab treatment in patients with HER2-positive breast tumors ≤ 10 mm without lymph node involvement (T1abN0) is insufficiently investigated. The aim of this systematic review and meta-analysis was to examine if adjuvant trastuzumab improves the prognosis in these patients. Databases were searched to identify interventional and observational studies evaluating the effect of trastuzumab on breast cancer specific survival (BCSS), disease free survival (DFS), distant recurrence free survival (DRFS), overall survival (OS) or recurrence free survival (RFS). Twelve studies examining the effect of trastuzumab and nine control studies without trastuzumab were identified (n = 6927). Median follow-up was 36–123 months. Significantly improved DFS (Hazard Ratio (HR) 0.14, p < 0.0001) and OS (HR 0.17, p = 0.011) were found for patients receiving trastuzumab and chemotherapy compared to no trastuzumab/chemotherapy based on four and two studies. The prognosis was good even for patients without trastuzumab treatment: 5-year DFS 88.3% and 5-year OS 95.9%. Highlights: ● Trastuzumab and chemotherapy improved disease free (DFS) and overall survival (OS). ● 5-year DFS was 95.3% with trastuzumab vs. 88.3% without trastuzumab. ● The prognosis was good even for patients without trastuzumab: 5-year OS 95.9%. ● All included studies were non-randomized with a potential risk of confounding.