A clinical systematic literature review of treatments among patients with advanced and/or metastatic human epidermal growth factor receptor 2 positive breast cancer
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: This systematic literature review aims to summarize the efficacy/effectiveness of treatments, including eribulin (ERI)-based and anti-human epidermal growth factor receptor 2 (HER2) treatments in advanced/metastatic HER2+ breast cancer. Methods: Three databases from 2016 to September 2021 were searched for clinical trials and observational studies in patients receiving first-line (1L) standard of care (SOC), second-line (2L) SOC or third-line or subsequent lines (3L+). Results: 2692 citations were screened, and 38 studies were included. Eleven studies were randomized-controlled trials (RCTs; 5 in 1L, 6 in 3L+), 6 were single-arm trials (5 in 1L, 1 in 3L+) and 21 were observational studies (13 in 1L, 6 in 2L, 4 in 3L+ [note that studies with subgroups for 1L, 2L, 3L+ are double-counted]). Longer overall survival (OS) was associated with 1L and 2L treatment, and for 3L+ studies that included ERI, ERI or trastuzumab (Tmab) + ERI led to longer OS than treatments of physician's choice (median OS of 11, 10 and 8.9 months, respectively). Progression-free survival was 9 months in Tmab + pertuzumab (Pmab) + ERI, 4 months in Tmab + ERI and 3.3 months in ERI. Conclusion: Available treatments provide a wide range of efficacy. However, later lines lack standardization and conclusions on comparative effectiveness are limited by differing trial designs. Thus, the chance of prolonged survival with new agents warrants further research.
Plain language summary
Breast cancer (BC) is a leading type of cancer worldwide. Once BC has spread to nearby or distance parts of the body, survival rate decrease. A growing type of BC is caused when there is too much of a protein called ‘HER2’. In this study, we looked at how well different treatments that target HER2 work for BC that has spread. We searched for studies published from 2016 to 2021 and found 38 studies to include. These studies looked at patients getting their first, second, or third or more rounds of treatment. Here are the key findings: treatment timing matters, people who got treatment earlier tended to live longer; in studies where people were on their third or more round of treatment and received eribulin (ERI) or the combination of ERI or trastuzumab (Tmab) tended to live longer compared with other treatments; and the time before the disease got worse varied with different treatments. For example, when people got Tmab + pertuzumab + ERI, it was 9 months before the disease got worse, with Tmab + ERI, it was 4 months, and with ERI alone, it was 3.3 months. In conclusion, there are many treatments available for this type of BC, but they vary in how well they work. Also, treatments in later rounds of therapy are not the same and there is no standard treatment that clinicians can provide. More research is needed to find out which treatments can help people live longer.
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Received: 27 September 2023
Accepted: 26 April 2024
Published online: 29 May 2024
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A clinical systematic literature review of treatments among patients with advanced and/or metastatic human epidermal growth factor receptor 2 positive breast cancer. (2024) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2023-0153
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